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Quality of Life After Fractional Flow Reserve-Guided PCI Compared with Coronary Bypass Surgery. Circulation Fearon, W. F., Zimmermann, F. M., Ding, V. Y., Zelis, J. M., Piroth, Z., Davidavicius, G., Mansour, S., Kharbanda, R., Ostlund-Papadogeorgos, N., Oldroyd, K. G., Wendler, O., Reardon, M. J., Woo, Y. J., Yeung, A. C., Pijls, N. H., De Bruyne, B., Desai, M., Hlatky, M. A., FAME 3 Investigators 2022

Abstract

Background: Previous studies have shown quality of life improves after coronary revascularization, more so after coronary artery bypass grafting (CABG) than after percutaneous coronary intervention (PCI). This study aimed to evaluate the impact of fractional flow reserve (FFR) guidance and current generation, zotarolimus drug-eluting stents (DES) on quality of life after PCI compared with CABG. Methods: The Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) 3 trial is a multicenter, international trial including 1500 patients with three-vessel coronary artery disease (CAD) who were randomly assigned to either CABG or FFR-guided PCI. Quality of life was measured using the European Quality of Life-5 Dimensions (EQ-5D) questionnaire at baseline, 1 and 12 months. The Canadian Cardiovascular Class (CCS) angina grade and working status were assessed at the same time points and at 6 months. The primary objective was to compare EQ-5D summary index at 12 months. Secondary endpoints included angina grade and work status. Results: The EQ-5D summary index at 12 months did not differ between the PCI and CABG groups (difference=0.001, 95% confidence interval (CI) -0.016 to 0.017, p=0.946). The trajectory of EQ-5D over the 12 months differed (p<0.001) between PCI and CABG: at 1 month, EQ-5D was 0.063 (95% CI 0.047 to 0.079) higher in the PCI group. A similar trajectory was found for the EQ visual analogue scale. The proportion of patients with CCS 2 or greater angina at 12 months was 6.2% vs 3.1% (OR=2.5, 95% CI 0.96 to 6.8), respectively in the PCI group compared with the CABG group. A greater percentage of younger patients (<65 years-old) were working at 12 months in the PCI group compared with the CABG group (68% vs 57%, OR=3.9, 95% CI 1.7 to 8.8). Conclusions: In the FAME 3 trial, quality of life after FFR-guided PCI with current generation DES compared with CABG was similar at one year. The rate of significant angina was low in both groups and not significantly different. The trajectory of improvement in quality of life was significantly better after PCI, as was working status in those less than 65 years old.

View details for DOI 10.1161/CIRCULATIONAHA.122.060049

View details for PubMedID 35369704