The impact of age on fractional flow reserve-guided percutaneous coronary intervention: a FAME (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) trial substudy.

Abstract

S0167-5273(14)01712-4 [pii]

AB - BACKGROUND: Fractional flow reserve (FFR)-guided percutaneous coronary

intervention (PCI) improved outcomes compared with an angiography-guided strategy

in patients with multivessel coronary artery disease (CAD). However, the effect

of age on FFR has not been well-studied. We aimed to evaluate the impact of age

on the favorable results of routine FFR-guided PCI for multivessel CAD. METHODS:

We compared 1 year outcomes between FFR-guided PCI and angiography-guided PCI in

the 512 patients enrolled in the FAME study <65 years old compared to the 493

patients >/= 65 years old. We also evaluated the effect of age on the FFR result

of varying degrees of visually estimated coronary stenosis. RESULTS: The 1-year

rate of death, myocardial infarction or repeat revascularization in the

angiography-guided group tended to be higher than in the FFR-guided group for

both those patients <65 (17.2% vs. 12.0%, P = 0.098) and those >/= 65 years old

(19.7% vs. 14.3%, P = 0.111) with no significant interaction based on age (P =

0.920). Older patients had higher FFR in vessels with 50% to 70% stenosis (0.83

+/- 0.11 vs. 0.80 +/- 0.13, P = 0.028) and in vessels with 71% to 90% stenosis

(0.69 +/- 0.15 vs. 0.65 +/- 0.16, P = 0.002). The proportion of functionally

significant lesions (FFR </= 0.80) in vessels with 71% to 90% stenosis was

significantly lower in elderly compared to younger patients (75.3% vs. 84.1%, P =

0.013). CONCLUSIONS: FFR-guided PCI is beneficial regardless of age, however,

older patients have fewer functionally significant lesions, despite a similar

angiographic appearance.