Table 1.
Published studies on revascularization strategies
| Study | Study design | No. of patients | Comparison arms | Inclusion criteria | Outcomes |
|---|---|---|---|---|---|
| BARI [7,8] | Randomized | 1,829 | PTCA vs. CABG | Angiographically documented MVD with clinically severe angina or objective evidence of ischemia requiring revascularization | 5-Year survival: 86.3% for PTCA vs. 89.3% for CABG (p = 0.19) |
| 10-Year survival: 71.0% for PTCA vs. 73.5% for CABG (p = 0.18) | |||||
| ARTS [9,10] | Randomized | 1,205 | PCI with BMS vs. CABG | Stable angina pectoris, unsta- ble angina or silent ischemia & at least 2 new lesions that were located in different vessels and territories (not including the LMCA) | MACCE-free survival at 1 year: 73.8% for PCI vs. 87.8 for CABG (p < 0.001) |
| Event-free survival at 5 years: 58.3% for PCI vs. 78.2% for CABG (p < 0.0001) | |||||
| SYNTAX [11,12] | Randomized | 1,800 (1,095 in 3VD, 705 in LMCA) | PCI with PES vs. CABG | 3 Vessel disease and LMCA disease (alone or with 1VD, 2VD, or 3VD) | 12-Month MACCE in all: 17.8% for PCI vs. 12.4% for CABG (p = 0.002) |
| 12-Month MACCE in 3 VD: 19.2% for PCI vs. 11.5% for CABG (p < 0.001) | |||||
| 5-Year MACCE in all: 37.3% for PCI vs. 26.9% for CABG (p < 0.001) | |||||
| 5-Year MACCE in 3 VD: 37.5% for PCI vs. 24.2% for CABG (p < 0.001) | |||||
| BEST [13] | Randomized | 880 | PCI with EES vs. CABG | Angiographically confirmed MVD with stenoses of more than 70% in major epicardial vessels in the territories of at least two coronary arteries | MACE at 2 years: 11.0% for PCI vs. 7.9% for CABG (p = 0.32) |
| MACE at 4.6 years: 15.3% for PCI vs. 10.6% for CABG (p = 0.04) | |||||
| FAME [17-19] | Randomized | 1,005 | FFR-guided PCI vs. angiography-guided PCI | MVD which lesions had stenoses of at least 50% of their diameter | 1-Year MACE: 13.2% for FFR 18.3% for angiography (p = 0.02) |
| 2-Year MACE: 17.9% for FFR 22.4% for angiography (p = 0.08), | |||||
| 5-Year MACE: 28.0% for FFR 31.0% for angiography (p = 0.31) | |||||
| FSS [21] | Prospective | 497 | SS vs. FSS | FFR guided group in the FAME | 1-Year MACE: 8.4%, 10.2%, and 20.9% in the low-, medium-, and high-SS groups vs. 9.0%, 11.3%, and 26.7% in the low-, medium- and high-FSS groups (Harrell’s C of the FSS, 0.677 vs. SS, 0.630; p = 0.02) |
| DANAMI-3-PRIMULTI [30] | Randomized | 627 | No further invasive treatment vs. FFR-guided CR before discharge | STEMI patients with an angiographic diameter stenosis of greater than 50% in one or more non-IRA after a PCI of an IRA | MACE in the non-IRA group at 27 months: 13% for FFR-guided CR vs. 22% for no further invasive treatment (p = 0.004) |
| Compare-Acute [31] | Randomized | 885 | FFR-guided CR vs. no revascularization of non-IRA | STEMI and MVD patients who had a non-IRA with a stenosis of 50% or greater after the primary PCI of an IRA | 12-Month MACCE: 7.8% for FFR-guided CR vs. 20.5% for no revascularization (p < 0.001) |
| FRAME-AMI | Randomized | 1,292 | FFR-guided strategy vs. angiographyguided strategy | AMI and MVD patients who had a non-IRA stenosis with > 50% stenosis after a PCI of an IRA | Recruiting |
BARI, Bypass Angioplasty Revascularization Investigation; PTCA, percutaneous transluminal coronary balloon angioplasty; CABG, coronary artery bypass grafting; MVD, multivessel disease; ARTS, Arterial Revascularization Therapies Study; PCI, percutaneous coronary intervention; BMS, bare metal stent; LMCA, left main coronary artery; MACCE, major adverse cardiac and cerebrovascular event; SYNTAX, SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery; 3VD, 3 vessel disease; PES, paclitaxel-eluting stent; BEST, Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease; EES, everolimus-eluting stent; MACE, major adverse cardiac events; FAME, Fractional Flow Reserve Versus Angiography for Multivessel Evaluation; FFR, fractional flow reserve; FSS, functional SYNTAX score; SS, SYNTAX score; DANAMI-3-PRIMULTI, Primary PCI in Patients With ST-elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization; CR, complete revascularization; STEMI, ST segment elevation myocardial infarction; IRA, infarct-related artery; FRAME-AMI, FFR versus Angiography-Guided Strategy for Management of AMI with Multivessel Disease.