Pooled Analysis Shows FFR-Guided PCI Reduces Cardiac Death and MI Compared With Medical Therapy

May 24, 2018—Results from a patient-level pooled analysis of the FAME 2, DANAMI-3-PRIMULTI, and COMPARE-ACUTE trials comparing fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) using drug-eluting stents versus medical therapy to reduce cardiac death and myocardial infarction (MI) were presented at EuroPCR 2018, taking place May 21–25 in Paris, France.

“Our results show that modern PCI, when guided by FFR, reduces so-called hard endpoints—the composite outcome of cardiac death or MI—when compared to an initial strategy using medical therapy,” said Frederik M. Zimmermann, MD, in EuroPCR’s press release. Dr. Zimmermann is with Catharina Hospital in Eindhoven, the Netherlands.

“Importantly, we found a relative risk reduction of approximately 30% when using FFR-guided treatment, which corresponded to an estimated absolute risk reduction of approximately 4.5% at 5 years,” said Dr. Zimmermann. “Our analyses also favored FFR-guided PCI when examining the composite of all-cause death or MI. Differences between groups were driven by a reduction in MI. No differences were observed for deaths from cardiac causes or deaths from any cause.

According to the press release from EuroPCR, each study demonstrated a clinical benefit in favor of FFR-guided PCI, including urgent revascularization in the primary endpoint. A total of 2,400 patients were included in analysis between all three trials. The pooled patient-level analysis was conducted because each trial individually was not powered for the endpoint of cardiac death or MI.

“In patients with stable coronary lesions, contemporary PCI guided by FFR reduces the risk of future MI or cardiac death independently of its impact on symptoms. Our results show that stents reduce the chances of having a future heart attack in clinically stable patients with such arteries.”