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Published on 31 August 2012

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FFR-guided cardiac stenting

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The FAME II (FFR-Guided Percutaneous Coronary Intervention (PCI) Plus Optimal Medical Treatment vs. Optimal Medical Treatment Alone in Patients with Stable Coronary Artery Disease) Trial examined the role of Fractional Flow Reserve (FFR) in the treatment of stable coronary artery disease in one or more vessels. FFR specifically identifies which coronary narrowings are responsible for obstructing blood flow to a patient’s heart muscle, and is measured using PressureWire FFR measurement technology from St. Jude Medical. The randomized trial compared percutaneous coronary intervention (PCI) guided by FFR plus the best available medical therapy (MT) to MT alone.
Results from the FAME II Trial:
  • At the time trial enrollment ended, primary endpoint event occurrence (death, heart attack or urgent revascularization) was significantly lower in patients with PCI plus MT than in patients with MT alone (4.3 versus 12.7 percent).
  • Instances of hospital re-admission leading to urgent revascularization were reduced by 86% for patients in the FFR-guided PCI arm of the trial. There was no evidence of significant difference in mortality or heart attack between patients with PCI plus MT and patients with MT alone.
  • Analysis suggests that the benefits of PCI plus MT may increase over time.
“The FAME II Trial provides new evidence-based guidance demonstrating the profound role that FFR and second-generation drug eluting stents can have in improving patient care,” said Dr. Bernard De Bruyne, M.D., Ph.D., of the OLV Clinic in Aalst, Belgium, and coordinating clinical investigator of the FAME II Trial. “Though there have been questions in the past about whether a patient should have a stent or is better off with medical treatment, we now know that if a lesion is significant as determined by FFR guidance, the stenting procedure will provide a better outcome. With this new knowledge, I believe that FFR should become the standard of care for treating patients with stable coronary artery disease and significant coronary narrowings.”
The FAME II trial provides insights about the benefits of coronary intervention and answers questions raised by the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial. The COURAGE trial demonstrated no difference in the outcomes between PCI plus MT compared to MT alone, but did not require use of FFR measurement technology. FAME II demonstrates that use of PressureWire FFR measurement technology has the ability to make a measurable difference in the outcome of patients. Where FFR found no evidence of ischemia-producing narrowings, patients were treated with medical treatment alone and were followed up in a registry. The rate of primary endpoint events for these patients was low (3 percent), indicating that FFR measurements can be beneficial in directing which patients would benefit from medical treatment.
“As the sponsor of the FAME family of studies, St. Jude Medical is proud to provide the medical community with additional evidence supporting the critically important role that the PressureWire FFR measurement technologies play in improving patient outcomes,” said Frank Callaghan, president of the St. Jude Medical Cardiovascular Division. “Publication of this groundbreaking research in the New England Journal of Medicine coinciding with a Hot Line session during ESC demonstrates that the role of FFR in guiding medical care has moved to broader and more mainstream acceptance within the cardiology community.”
The FAME II Trial began enrolling patients in May 2010. At the time enrollment was stopped in January 2012, 1,220 patients with stable coronary artery disease were enrolled at 28 centers across Europe, the U.S. and Canada. FFR was measured using the PressureWire™ Aeris or PressureWire™ Certus from St. Jude Medical.
Enrollment in the St. Jude Medical-sponsored FAME II Trial was halted after an Independent Data Safety Monitoring Board (DSMB) found a highly statistically significant reduction in unplanned hospitalizations and urgent revascularizations in patients enrolled in the PCI plus MT arm of the trial. The DSMB therefore deemed it unethical to continue to randomize patients into the arm of the trial receiving MT alone. As a result, patients already enrolled in the trial continue to be followed, but no additional patients were added.
Health economics data derived from the FAME II Trial are expected to be presented later this year.
About FFR
FFR is a physiological index used to determine the hemodynamic severity of narrowings (or lesions) in the coronary arteries, and is measured using St. Jude Medical PressureWire™ Aeris and PressureWire™ Certus. FFR specifically identifies which coronary narrowings are responsible for obstructing the flow of blood to a patient’s heart muscle (called ischemia), and helps guide the interventional cardiologist in determining which lesions warrant stenting, resulting in improved patient outcomes and reduced healthcare costs.
About the Original FAME Trial
The original FAME (Fractional Flow Reserve (FFR) vs. Angiography in Multivessel Evaluation) Trial compared outcomes for patients whose treatment was guided by FFR to those whose treatment was guided only by angiography using St. Jude Medical PressureWire Certus™ technology. Results demonstrated improved clinical outcomes in patients with stable coronary artery disease and two or three vessel disease as well as cost savings.
About St. Jude Medical
St. Jude Medical develops medical technology and services that focus on putting more control into the hands of those who treat cardiac, neurological and chronic pain patients worldwide. The company is dedicated to advancing the practice of medicine by reducing risk wherever possible and contributing to successful outcomes for every patient. St. Jude Medical is headquartered in St. Paul, Minn. and has four major focus areas that include: cardiac rhythm management, atrial fibrillation, cardiovascular and neuromodulation. For more information, please visit sjm.com.


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