New European guidelines issued in November 2008 emphasised speed of action and the importance of reperfusion therapy to restore blood flow to the heart and improve survival rates. The benefits of PCI are less clear in patients with stable coronary artery disease; PCI has been shown to improve symptoms, but the impact on prognosis is still a matter of debate.
The cornerstone of PCI is the technique of angioplasty, by which either bare-metal or drug-releasing stents are located within the coronary arteries at points of occlusion. The FAME study, reported in the 15 January issue of the New England Journal of Medicine, was a randomised trial designed to assess the most effective method of locating the stent in patients with multivessel disease: conventional angiography (visualisation of the artery) or a new technique of “fractional flow reserve” (FFR), by which a tiny wire with a sensor is threaded through the coronary artery to the point of occlusion and blood flow measured to determine if the lesion is restricting blood flow and causing ischemia.(1)
The study, conducted in 20 European and US centres, randomised more than 1000 patients with multivessel coronary disease to either of the two methods for placement of stents. Results showed that one-third fewer stents were used in the FFR group and the difference in composite outcome at one year was significant: the FFR group showed a 28% lower incidence of major adverse cardiac events (repeat angioplasty, heart attack or death) - 18.3% vs. 13.2%.
The implication in these results is that placing stents in lesions not responsible for ischemia is not only unnecessary, but may cause worse outcomes.
Commenting on the study on behalf of the European Society of Cardiology, Professor Uwe Zeymer from the Herzzentrum, Ludwigshafen, Germany, said that, while PCI is clearly beneficial for the relief of symptoms in patients with stable angina, the prognostic impact of PCI in the patient group in this study is still a matter of debate. One reason for this, he explained, may be that some stent procedures are performed solely on the basis of “oculo stenotic reflex” (the visual presence of a stenosis).
However, he added: “One method which is easy to perform and readily available during diagnostic angiography is measurement of the fractional flow reserve, a method which can distinguish between hemodynamically relevant and irrelevant stenoses. The latter do not need intervention and can be safely treated with medical therapy. The FAME study has now shown that by using FFR we can improve the prognosis of patients and reduce the number of unnecessary interventions. As a result, this method should be used in patients with stable symptoms and without documentation of ischemia by another method. In patients with multivessel disease in particular, FFR can increase the safety and efficacy of coronary revascularisation. In addition, FFR seems cost effective and avoids unnecessary and potentially harmful interventions.”
ESC Press Office | alfa
Further reports about: > FAME > FFR > PCI > Reperfusion therapy > Stents > acute myocardial infarction > arterial blood flow measurement > blood flow > efficacy > fractional flow reserve > ischemia > multivessel coronary disease > multivessel disease > oculo stenotic reflex > percutaneous coronary intervention > stenosis
A first look at interstitial fluid flow in the brain
05.07.2018 | American Institute of Physics
A sentinel to watch over ocular pressure
04.07.2018 | Fraunhofer Institute for Microelectronic Circuits and Systems
A new manufacturing technique uses a process similar to newspaper printing to form smoother and more flexible metals for making ultrafast electronic devices.
The low-cost process, developed by Purdue University researchers, combines tools already used in industry for manufacturing metals on a large scale, but uses...
For the first time ever, scientists have determined the cosmic origin of highest-energy neutrinos. A research group led by IceCube scientist Elisa Resconi, spokesperson of the Collaborative Research Center SFB1258 at the Technical University of Munich (TUM), provides an important piece of evidence that the particles detected by the IceCube neutrino telescope at the South Pole originate from a galaxy four billion light-years away from Earth.
To rule out other origins with certainty, the team led by neutrino physicist Elisa Resconi from the Technical University of Munich and multi-wavelength...
For the first time a team of researchers have discovered two different phases of magnetic skyrmions in a single material. Physicists of the Technical Universities of Munich and Dresden and the University of Cologne can now better study and understand the properties of these magnetic structures, which are important for both basic research and applications.
Whirlpools are an everyday experience in a bath tub: When the water is drained a circular vortex is formed. Typically, such whirls are rather stable. Similar...
Physicists working with Roland Wester at the University of Innsbruck have investigated if and how chemical reactions can be influenced by targeted vibrational excitation of the reactants. They were able to demonstrate that excitation with a laser beam does not affect the efficiency of a chemical exchange reaction and that the excited molecular group acts only as a spectator in the reaction.
A frequently used reaction in organic chemistry is nucleophilic substitution. It plays, for example, an important role in in the synthesis of new chemical...
Optical spectroscopy allows investigating the energy structure and dynamic properties of complex quantum systems. Researchers from the University of Würzburg present two new approaches of coherent two-dimensional spectroscopy.
"Put an excitation into the system and observe how it evolves." According to physicist Professor Tobias Brixner, this is the credo of optical spectroscopy....
13.07.2018 | Event News
12.07.2018 | Event News
03.07.2018 | Event News
20.07.2018 | Power and Electrical Engineering
20.07.2018 | Information Technology
20.07.2018 | Materials Sciences