Fractional Flow Reserve-Guided PCI as Compared with Coronary
Bypass Surgery

J 2022

Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery

FEARON, William F, Frederik M ZIMMERMANN, De Bruyne BERNARD, Zsolt PIROTH, M. VAN STRATEN ALBERT H et. al.

Basic information

Original name

Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery

Authors

FEARON, William F (guarantor), Frederik M ZIMMERMANN, De Bruyne BERNARD, Zsolt PIROTH, M. VAN STRATEN ALBERT H, Laszlo SZEKELY, Giedrius DAVIDAVICIUS, Gintaras KALINAUSKAS, Samer MANSOUR, Rajesh KHARBANDA, Nikolaos OSTLUND-PAPADOGEORGOS, Adel AMINIAN, Keith G OLDROYD, Nawwar AL-ATTAR, Nikola JAGIC, Jan-Henk E DAMBRINK, Petr KALA (203 Czech Republic, belonging to the institution), Oskar ANGERAS, Philip MACCARTHY, Olaf WENDLER, Filip CASSELMAN, Nils WITT, Kreton MAVROMATIS, Steven E S MINER, Jaydeep SARMA, Thomas ENGSTROM, Evald H CHRISTIANSEN, Pim A L TONINO, Michael J REARDON, Di LU, Victoria Y DING, Yuhei KOBAYASHI, Mark A HLATKY, Kenneth W MAHAFFEY, Manisha DESAI, Y Joseph WOO, Alan C YEUNG and Nico H J PIJLS

Edition

New England Journal of Medicine, Waltham, Massachussetts Medical Society, 2022, 0028-4793

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 158.500

RIV identification code

RIV/00216224:14110/22:00128484

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1056/NEJMoa2112299

UT WoS

000714422300001

Keywords in English

Fractional Flow Reserve-Guided PCI; Coronary Bypass Surgery

Abstract

V originále

BACKGROUND Patients with three-vessel coronary artery disease have been found to have better outcomes with coronary-artery bypass grafting (CABG) than with percutaneous coronary intervention (PCI), but studies in which PCI is guided by measurement of fractional flow reserve (FFR) have been lacking. METHODS In this multicenter, international, noninferiority trial, patients with three-vessel coronary artery disease were randomly assigned to undergo CABG or FFR-guided PCI with current-generation zotarolimus-eluting stents. The primary end point was the occurrence within 1 year of a major adverse cardiac or cerebrovascular event, defined as death from any cause, myocardial infarction, stroke, or repeat revascularization. Noninferiority of FFR-guided PCI to CABG was prespecified as an upper boundary of less than 1.65 for the 95% confidence interval of the hazard ratio. Secondary end points included a composite of death, myocardial infarction, or stroke; safety was also assessed. RESULTS A total of 1500 patients underwent randomization at 48 centers. Patients assigned to undergo PCI received a mean (+/- SD) of 3.7 +/- 1.9 stents, and those assigned to undergo CABG received 3.4 +/- 1.0 distal anastomoses. The 1-year incidence of the composite primary end point was 10.6% among patients randomly assigned to undergo FFR-guided PCI and 6.9% among those assigned to undergo CABG (hazard ratio, 1.5; 95% confidence interval [CI], 1.1 to 2.2), findings that were not consistent with noninferiority of FFR-guided PCI (P = 0.35 for noninferiority). The incidence of death, myocardial infarction, or stroke was 7.3% in the FFR-guided PCI group and 5.2% in the CABG group (hazard ratio, 1.4; 95% CI, 0.9 to 2.1). The incidences of major bleeding, arrhythmia, and acute kidney injury were higher in the CABG group than in the FFR-guided PCI group. CONCLUSIONS In patients with three-vessel coronary artery disease, FFR-guided PCI was not found to be noninferior to CABG with respect to the incidence of a composite of death, myocardial infarction, stroke, or repeat revascularization at 1 year.

Citovat

FEARON, William F, Frederik M ZIMMERMANN, De Bruyne BERNARD, Zsolt PIROTH, M. VAN STRATEN ALBERT H, Laszlo SZEKELY, Giedrius DAVIDAVICIUS, Gintaras KALINAUSKAS, Samer MANSOUR, Rajesh KHARBANDA, Nikolaos OSTLUND-PAPADOGEORGOS, Adel AMINIAN, Keith G OLDROYD, Nawwar AL-ATTAR, Nikola JAGIC, Jan-Henk E DAMBRINK, Petr KALA, Oskar ANGERAS, Philip MACCARTHY, Olaf WENDLER, Filip CASSELMAN, Nils WITT, Kreton MAVROMATIS, Steven E S MINER, Jaydeep SARMA, Thomas ENGSTROM, Evald H CHRISTIANSEN, Pim A L TONINO, Michael J REARDON, Di LU, Victoria Y DING, Yuhei KOBAYASHI, Mark A HLATKY, Kenneth W MAHAFFEY, Manisha DESAI, Y Joseph WOO, Alan C YEUNG and Nico H J PIJLS. Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery. New England Journal of Medicine. Waltham: Massachussetts Medical Society, 2022, vol. 386, No 2, p. 128-137. ISSN 0028-4793. Available from: https://dx.doi.org/10.1056/NEJMoa2112299.

@article{2251950,
   author = {Fearon, William F and Zimmermann, Frederik M and Bernard, De Bruyne and Piroth, Zsolt and van Straten Albert H, M. and Szekely, Laszlo and Davidavicius, Giedrius and Kalinauskas, Gintaras and Mansour, Samer and Kharbanda, Rajesh and OstlundandPapadogeorgos, Nikolaos and Aminian, Adel and Oldroyd, Keith G and AlandAttar, Nawwar and Jagic, Nikola and Dambrink, JanandHenk E and Kala, Petr and Angeras, Oskar and MacCarthy, Philip and Wendler, Olaf and Casselman, Filip and Witt, Nils and Mavromatis, Kreton and Miner, Steven E S and Sarma, Jaydeep and Engstrom, Thomas and Christiansen, Evald H and Tonino, Pim A L and Reardon, Michael J and Lu, Di and Ding, Victoria Y and Kobayashi, Yuhei and Hlatky, Mark A and Mahaffey, Kenneth W and Desai, Manisha and Woo, Y Joseph and Yeung, Alan C and Pijls, Nico H J},
   article_location = {Waltham},
   article_number = {2},
   doi = {http://dx.doi.org/10.1056/NEJMoa2112299},
   keywords = {Fractional Flow Reserve-Guided PCI; Coronary Bypass Surgery},
   language = {eng},
   issn = {0028-4793},
   journal = {New England Journal of Medicine},
   title = {Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery},
   url = {https://www.nejm.org/doi/10.1056/NEJMoa2112299},
   volume = {386},
   year = {2022}
}

TY  - JOUR
ID  - 2251950
AU  - Fearon, William F - Zimmermann, Frederik M - Bernard, De Bruyne - Piroth, Zsolt - van Straten Albert H, M. - Szekely, Laszlo - Davidavicius, Giedrius - Kalinauskas, Gintaras - Mansour, Samer - Kharbanda, Rajesh - Ostlund-Papadogeorgos, Nikolaos - Aminian, Adel - Oldroyd, Keith G - Al-Attar, Nawwar - Jagic, Nikola - Dambrink, Jan-Henk E - Kala, Petr - Angeras, Oskar - MacCarthy, Philip - Wendler, Olaf - Casselman, Filip - Witt, Nils - Mavromatis, Kreton - Miner, Steven E S - Sarma, Jaydeep - Engstrom, Thomas - Christiansen, Evald H - Tonino, Pim A L - Reardon, Michael J - Lu, Di - Ding, Victoria Y - Kobayashi, Yuhei - Hlatky, Mark A - Mahaffey, Kenneth W - Desai, Manisha - Woo, Y Joseph - Yeung, Alan C - Pijls, Nico H J
PY  - 2022
TI  - Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery
JF  - New England Journal of Medicine
VL  - 386
IS  - 2
SP  - 128-137
EP  - 128-137
PB  - Massachussetts Medical Society
SN  - 00284793
KW  - Fractional Flow Reserve-Guided PCI
KW  - Coronary Bypass Surgery
UR  - https://www.nejm.org/doi/10.1056/NEJMoa2112299
N2  - BACKGROUND Patients with three-vessel coronary artery disease have been found to have better outcomes with coronary-artery bypass grafting (CABG) than with percutaneous coronary intervention (PCI), but studies in which PCI is guided by measurement of fractional flow reserve (FFR) have been lacking. METHODS In this multicenter, international, noninferiority trial, patients with three-vessel coronary artery disease were randomly assigned to undergo CABG or FFR-guided PCI with current-generation zotarolimus-eluting stents. The primary end point was the occurrence within 1 year of a major adverse cardiac or cerebrovascular event, defined as death from any cause, myocardial infarction, stroke, or repeat revascularization. Noninferiority of FFR-guided PCI to CABG was prespecified as an upper boundary of less than 1.65 for the 95% confidence interval of the hazard ratio. Secondary end points included a composite of death, myocardial infarction, or stroke; safety was also assessed. RESULTS A total of 1500 patients underwent randomization at 48 centers. Patients assigned to undergo PCI received a mean (+/- SD) of 3.7 +/- 1.9 stents, and those assigned to undergo CABG received 3.4 +/- 1.0 distal anastomoses. The 1-year incidence of the composite primary end point was 10.6% among patients randomly assigned to undergo FFR-guided PCI and 6.9% among those assigned to undergo CABG (hazard ratio, 1.5; 95% confidence interval [CI], 1.1 to 2.2), findings that were not consistent with noninferiority of FFR-guided PCI (P = 0.35 for noninferiority). The incidence of death, myocardial infarction, or stroke was 7.3% in the FFR-guided PCI group and 5.2% in the CABG group (hazard ratio, 1.4; 95% CI, 0.9 to 2.1). The incidences of major bleeding, arrhythmia, and acute kidney injury were higher in the CABG group than in the FFR-guided PCI group. CONCLUSIONS In patients with three-vessel coronary artery disease, FFR-guided PCI was not found to be noninferior to CABG with respect to the incidence of a composite of death, myocardial infarction, stroke, or repeat revascularization at 1 year.
ER  -

FEARON, William F, Frederik M ZIMMERMANN, De Bruyne BERNARD, Zsolt PIROTH, M. VAN STRATEN ALBERT H, Laszlo SZEKELY, Giedrius DAVIDAVICIUS, Gintaras KALINAUSKAS, Samer MANSOUR, Rajesh KHARBANDA, Nikolaos OSTLUND-PAPADOGEORGOS, Adel AMINIAN, Keith G OLDROYD, Nawwar AL-ATTAR, Nikola JAGIC, Jan-Henk E DAMBRINK, Petr KALA, Oskar ANGERAS, Philip MACCARTHY, Olaf WENDLER, Filip CASSELMAN, Nils WITT, Kreton MAVROMATIS, Steven E S MINER, Jaydeep SARMA, Thomas ENGSTROM, Evald H CHRISTIANSEN, Pim A L TONINO, Michael J REARDON, Di LU, Victoria Y DING, Yuhei KOBAYASHI, Mark A HLATKY, Kenneth W MAHAFFEY, Manisha DESAI, Y Joseph WOO, Alan C YEUNG and Nico H J PIJLS. Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery. \textit{New England Journal of Medicine}. Waltham: Massachussetts Medical Society, 2022, vol.~386, No~2, p.~128-137. ISSN~0028-4793. Available from: https://dx.doi.org/10.1056/NEJMoa2112299.

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