FAMOUS-NSTEMI: The BHF FFR vs. Angiography in Guiding Management to Optimize NSTEMI Outcomes

In patients with non-ST segment elevation myocardial infarction (NSTEMI), angiography-guided management was associated with higher rates of coronary revascularization compared with fractional flow reserve (FFR)-guided management, according to results from the FAMOUS-NSTEMI Trial presented Sept. 1 as part of ESC Congress 2014 and simultaneously published in the European Heart Journal.

The multi-center trial randomized 350 NSTEMI patients to angiography-guided management or FFR-guided management. According to study investigators, the proportion of patients treated initially by medical therapy was higher in the FFR-guided group (22.7 percent) than in the angiography-guided group (13.2 percent). They also noted that FFR disclosure resulted in a change in treatment between medical therapy, percutaneous coronary intervention or coronary artery bypass graft surgery in more than one-fifth of patients. At one year, revascularization remained lower in the FFR-guided group [79 percent vs. 86.8 percent, difference 7.8 percent). In addition, there were no statistically significant differences in health outcomes and quality of life between the two groups.

The study investigators said their findings show that compared with angiography-guided standard care, routine FFR measurement is feasible and safe. They recommend a large randomized trial to "definitively assess the cost-effectiveness of an FFR-guided management strategy in invasively managed NSTEMI patients."

Keywords: Myocardial Infarction, Coronary Angiography, Quality of Life, Coronary Artery Bypass, Angioplasty, Balloon, Coronary

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