Layland, J. et al. (2015) Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction: the British Heart Foundation FAMOUS-NSTEMI randomized trial. European Heart Journal, 36(2), pp. 100-111. (doi: 10.1093/eurheartj/ehu338) (PMID:25179764) (PMCID:PMC4291317)
|
Text
102629.pdf - Published Version Available under License Creative Commons Attribution Non-commercial. 707kB |
Abstract
Aim: We assessed the management and outcomes of non-ST segment elevation myocardial infarction (NSTEMI) patients randomly assigned to fractional flow reserve (FFR)-guided management or angiography-guided standard care. Methods and results: We conducted a prospective, multicentre, parallel group, 1 : 1 randomized, controlled trial in 350 NSTEMI patients with ≥ coronary stenosis ≥30% of the lumen diameter assessed visually (threshold for FFR measurement) (NCT01764334). Enrolment took place in six UK hospitals from October 2011 to May 2013. Fractional flow reserve was disclosed to the operator in the FFR-guided group (n = 176). Fractional flow reserve was measured but not disclosed in the angiography-guided group (n = 174). Fractional flow reserve ≤0.80 was an indication for revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). The median (IQR) time from the index episode of myocardial ischaemia to angiography was 3 (2, 5) days. For the primary outcome, the proportion of patients treated initially by medical therapy was higher in the FFR-guided group than in the angiography-guided group [40 (22.7%) vs. 23 (13.2%), difference 95% (95% CI: 1.4%, 17.7%), P = 0.022]. Fractional flow reserve disclosure resulted in a change in treatment between medical therapy, PCI or CABG in 38 (21.6%) patients. At 12 months, revascularization remained lower in the FFR-guided group [79.0 vs. 86.8%, difference 7.8% (−0.2%, 15.8%), P = 0.054]. There were no statistically significant differences in health outcomes and quality of life between the groups. Conclusion: In NSTEMI patients, angiography-guided management was associated with higher rates of coronary revascularization compared with FFR-guided management. A larger trial is necessary to assess health outcomes and cost-effectiveness.
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Berry, Professor Colin and McConnachie, Professor Alex and Lee, Matthew and Briggs, Professor Andrew and Layland, Dr Jamie and Ford, Professor Ian |
| Authors: | Layland, J., Oldroyd, K. G., Curzen, N., Sood, A., Balachandran, K., Das, R., Junejo, S., Ahmed, N., Lee, M.M.Y., Shaukat, A., O'Donnell, A., Nam, J., Briggs, A., Henderson, R., McConnachie, A., Berry, C., Hannah, A., Stewart, A., Metcalfe, M., Norrie, J., Chowdhary, S., Clark, A., Henderson, R., Balachandran, K., Berry, C., Baird, G., O'Donnell, A., Sood, A., Curzen, N., Das, R., Ford, I., Layland, J., Junejo, S., and Oldroyd, K. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre |
| Journal Name: | European Heart Journal |
| Publisher: | Oxford University Press |
| ISSN: | 0195-668X |
| ISSN (Online): | 1522-9645 |
| Copyright Holders: | Copyright © 2014 The Authors |
| First Published: | First publshed in European Heart Journal 36(2):100-111 |
| Publisher Policy: | Reproduced under a Creative Commons License |
University Staff: Request a correction | Enlighten Editors: Update this record
Funder and Project Information
Funder and Project Information