Quality of life similar after FFR-guided PCI, CABG for three-vessel coronary disease
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WASHINGTON — In patients with three-vessel CAD, those who underwent fractional flow reserve-guided PCI had similar quality of life at 1 year compared with those who underwent CABG, according to new data from the FAME 3 trial.
However, the PCI group had faster improvement in quality of life during the first year after their procedure and had a greater percentage of patients younger than 65 years who were able to return to work than the CABG group, researchers reported at the American College of Cardiology Scientific Session.
As Healio previously reported, in the main results of the FAME 3 trial of 1,500 patients with three-vessel CAD (mean age, 65 years; 82% men), PCI guided by FFR failed to meet noninferiority for reduction of MACCE at 1 year compared with CABG. The group assigned the FFR-guided strategy underwent PCI with a second-generation drug-eluting stent on a particular lesion if its FFR was 0.8 or less.
For the present analysis, presented here by Frederik M. Zimmermann, MD, interventional cardiologist at Catharina Hospital in Eindhoven, the Netherlands, the researchers compared the PCI and CABG groups in terms of quality of life, angina and work status. The results were simultaneously published in Circulation.
“Previous studies have shown improved quality of life after coronary revascularization, particularly after CABG as opposed to PCI,” Zimmermann said during the presentation. “However, prior studies did not use FFR to guide PCI and did not use current-generation drug-eluting stents, both of which have been shown to improve outcomes.”
The primary endpoint, quality of life at 1 year as measured by the EQ-5D summary index, was almost identical in both groups (PCI, 0.874; CABG, 0.873; P = .95), Zimmermann said during a presentation. However, the trajectory of improvement favored the PCI group (P < .001). The results were consistent across subgroups, he noted.
The percentage of significant angina, defined as Canadian Cardiovascular Society class 2 angina or higher, declined in both groups at 1 year and did not significantly differ (PCI, 6.2%; CABG, 3.1%; OR = 2.5; 95% CI, 0.96-6.8), but numerically favored the CABG group, according to the researchers.
In the overall cohort, the percentage of patients working full or part time at 1 year did not differ (OR = 1.2; 95% CI, 0.5-2.6), but when the analysis was limited to patients younger than 65 years, the PCI group was more likely to return to work at 1 year than the CABG group (OR = 3.9; 95% CI, 1.7-8.8), Zimmermann said, noting the difference was even greater at 1 month (OR = 19.4; 95% CI, 8.5-44.6).
“In patients with three-vessel disease, quality of life improved at 12 months after FFR-guided PCI with current-generation drug-eluting stents compared with CABG,” Zimmermann said during the presentation. “FFR-guided PCI results in faster improvement in quality of life than CABG during the first year after revascularization and improves working status in patients younger than 65 years old. The rate of significant angina was greatly reduced in both groups and [was] not significantly different at 12 months.”
In a discussion after the presentation, Allen Jeremias, MD, FACC, interventional cardiologist, director of interventional cardiology research and associate director of the cardiac catheterization laboratory at St. Francis Hospital in Roslyn, New York, said the analysis was “yet another important study in the field of physiology,” but noted that “the truth is CABG is better, so why do a cost-effectiveness analysis or quality-of-life analysis on a treatment that is worse than the comparator? But maybe FAME 3 is the exception to the rule here. This may be a fair discussion to have in the context of shared decision-making.”
Reference:
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Zimmermann FD, et al. Featured Clinical Research I. Presented at: American College of Cardiology Scientific Session; April 2-4, 2022; Washington, D.C. (hybrid meeting).
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