Author + information
- Received July 30, 2009
- Revision received November 17, 2009
- Accepted November 24, 2009
- Published online June 22, 2010.
- Pim A.L. Tonino, MD*,* (, )
- William F. Fearon, MD†,
- Bernard De Bruyne, MD, PhD‡,
- Keith G. Oldroyd, MD§,
- Massoud A. Leesar, MD∥,
- Peter N. Ver Lee, MD¶,
- Philip A. MacCarthy, MD, PhD#,
- Marcel van't Veer, MSc, PhD* and
- Nico H.J. Pijls, MD, PhD*
- ↵*Reprint requests and correspondence:
Dr. Pim A. L. Tonino, Department of Cardiology, Catharina Hospital, Michelangelolaan 2, Eindhoven 5623 EJ, the Netherlands
Objectives The purpose of this study was to investigate the relationship between angiographic and functional severity of coronary artery stenoses in the FAME (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation) study.
Background It can be difficult to determine on the coronary angiogram which lesions cause ischemia. Revascularization of coronary stenoses that induce ischemia improves a patient's functional status and outcome. For stenoses that do not induce ischemia, however, the benefit of revascularization is less clear.
Methods In the FAME study, routine measurement of the fractional flow reserve (FFR) was compared with angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease. The use of the FFR in addition to angiography significantly reduced the rate of all major adverse cardiac events at 1 year. Of the 1,414 lesions (509 patients) in the FFR-guided arm of the FAME study, 1,329 were successfully assessed by the FFR and are included in this analysis.
Results Before FFR measurement, these lesions were categorized into 50% to 70% (47% of all lesions), 71% to 90% (39% of all lesions), and 91% to 99% (15% of all lesions) diameter stenosis by visual assessment. In the category 50% to 70% stenosis, 35% were functionally significant (FFR ≤0.80) and 65% were not (FFR >0.80). In the category 71% to 90% stenosis, 80% were functionally significant and 20% were not. In the category of subtotal stenoses, 96% were functionally significant. Of all 509 patients with angiographically defined multivessel disease, only 235 (46%) had functional multivessel disease (≥2 coronary arteries with an FFR ≤0.80).
Conclusions Angiography is inaccurate in assessing the functional significance of a coronary stenosis when compared with the FFR, not only in the 50% to 70% category but also in the 70% to 90% angiographic severity category.
- coronary angiography
- drug-eluting stent
- fractional flow reserve
- multivessel coronary artery disease
- percutaneous coronary intervention
Supported by unrestricted research grants from St. Jude Medical and Stichting Vrienden van het Hart Zuidoost Brabant. Dr. De Bruyne has received research grants from The Meijer Lavino Foundationfor Cardiac Research. Dr. Oldroyd has received speaker fees from Biosensors and Boston Scientific. Dr. Leesar has received fees from the Speakers' Bureau for IVUS of Boston Scientific. Dr. Ver Lee has received lecture fees from St. Jude Medical. Dr. Pijls has received an institutional research grant for the Catharina Hospital Eindhoven from St. Jude Medical.
- Received July 30, 2009.
- Revision received November 17, 2009.
- Accepted November 24, 2009.
- American College of Cardiology Foundation