By Ed Susman

SAN FRANCISCO, CA — Doctors suggested that by performing an intravascular measurement of blood flow interventionalists will be able to more accurately determine who needs angioplasty procedures and who can be safely watched.

William F. Fearon, MD, associate director of interventional cardiology at  Stanford University Medical Center, reported that his study determined that utilization of fractional flow reserve plus angiography rather than angiography  alone the two-year risk of death or myocardial infarction was  significantly lower.

Avoiding the use of angioplasty plus stenting also favorably changed the economic bottom lie, he said. The average cost of angiography-guided stenting was $6,007 while fractional flow reserve-guided procedure cost about $5,332.

Dr. Fearon reported the two-year results of the FAME study at the  21^st annual Transcatheter Cardiovascular Therapeutics meeting here.

The absolute difference in death or myocardial infarction was 4.3%  which was significant (P =0.03), Fearon said. But the difference in the combined the combined endpoint of death, heart attack  or repeat revascularization, which was favored FFR at one year, was no  longer statistically significant at two years, (P=0.07). Nonetheless Fearon said the two-year results demonstrate that the  benefit of using fractional flow reserve was durable.

The trial randomized 1005 patients with multivessel coronary artery  disease to undergo stenting guided by angiography or guided by  angiography plus fraction flow reserve, measured by placing a device through the catheter and taking readings of blood flow on both sides of the lesion. If the blood flow past the lesion was greater that 0.80, stenting was deferred.  The trialists deployed St. Jude Medical’s PressureWire Certus technology.

Stephen Ellis, MD

–09-24-2009