New Diagnostic Tool Could Help Cut Down on Unnecessary Stenting in Patients with Coronary Artery Disease

January 19, 2009
Todd Kunkler

Are doctors implanting too many stents? Can a new diagnostic tool enable physicians to get a better picture of coronary arterial blood flow and determine whether medication may be a better option than stenting?

Are doctors implanting too many stents? Can a new diagnostic tool enable physicians to get a better picture of coronary arterial blood flow and determine whether medication may be a better option than stenting? The answer to these questions may be “yes,” according to results from the Fractional Flow Reserve versus Angiography for Guiding PCI in Patients with Multivessel Coronary Artery Disease (FAME) study.

A Stanford School of Medicine news release said that FAME study results support the use of fractional flow reserve (FFR) in patients with coronary artery disease to “measure whether blood flow is actually reduced to a dangerous level beyond any apparent narrowing.”

William Fearon, MD, co-principal investigator of the FAME study and assistant professor of cardiovascular medicine at the Stanford University School of Medicine, said that “Not only were the outcomes better, the cost was less. Now there’s scientific support for cardiologists to apply this new technique.”

The study results suggest that doctors should use FFR and “go one step beyond the traditional method of relying solely on X-rays from a coronary angiogram to determine which arteries should be stented for patients with coronary artery disease.” This is important because, according to the news release, “in many cases, cardiologists will routinely prop open with a stent any arteries that look significantly narrowed on the angiogram,” Fearon said. “The problem is you can’t always tell from the angiogram whether this is absolutely necessary.”

Half of the patients in the FAME study were evaluated using traditional angiogram; the other half underwent angiogram with FFR. Researchers found that “patients who received the additional blood flow test received one-third fewer stents than the group examined only with an angiogram. Those patients received 2.7 stents on average. The other half who had their blood flow measured in each artery, received only 1.9 stents on average.”

Analysis of data at one-year follow-up indicated that “within the traditional group, 18.4 percent of the patients had died, suffered a heart attack or needed a bypass surgery or repeat stent procedure, compared with 13.2 percent among those who received the additional pressure wire test.”

“The take-home message is that the wire is able to give you more information about whether a coronary narrowing is truly causing abnormal blood flow to the heart,” Fearon said. “Some narrowings that might look bad would respond just as well to medication, while others that appear innocent may benefit from stenting. By measuring FFR, one is better able to make this distinction and improve the patient’s outcome, while also saving health-care dollars.”

The complete study results are published in the January 15 edition of the New England Journal of Medicine. Click here to access an abstract.