Percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) was not found to be noninferior to coronary artery bypass grafting (CABG) for patients with three-vessel coronary artery disease (3V-CAD), according to new research presented Nov. 4 at TCT 2021.
The analysis, which was also published in the New England Journal of Medicine, included 1,500 patients who were randomized to undergo FFR-guided PCI or CABG. All patients presented with 3V-CAD at one of 48 facilities in North America, Europe, Australia or Asia.
FFR-guided PCI was performed using current-generation zotarolimus-eluting stents, the authors noted, while CABG was performed with a recommendation to use multiple arterial grafts.
Overall, 757 patients underwent FFR-guided PCI and 743 patients underwent CABG. The primary endpoint of death, myocardial infarction (MI), stroke or repeat revascularization after one year was 10.6% for PCI patients and 6.9% for CABG patients. Individually, the one-year rate of death, MI and stroke were not significantly different between FFR-guided PCI and CABG. PCI patients, however, were more likely to require repeat revascularization than CABG patients (5.9% vs. 3.9%).
When SYNTAX scores, which evaluate the complexity of CAD, were used as the basis of analysis, the team found that the rate of adverse cardiovascular outcomes was lower for PCI than CABG when the patient had a low SYNTAX score. When the SYNTAX score was intermediate or high, on the other hand, the rate of adverse cardiovascular outcomes was higher for PCI than CABG.
“FFR-guided PCI with a current generation drug-eluting stent performed favorably in comparison with CABG in 3V-CAD with less complex disease according to the SYNTAX score,” lead author William F. Fearon, MD, a professor of medicine at Stanford University School of Medicine and chief of the cardiology section for the VA Palo Alto Health Care System, said in a statement. “In patients with more complex 3-V CAD, CABG remains the treatment of choice.”