SCAI Statement on FAME 2, Presented at the European Society of Cardiology 2012 Congress and Published in NEJM
WASHINGTON, D.C. (August 28, 2012) — The FAME 2 trial will improve treatment strategies for patients with stable ischemic heart disease. FAME 2 indicates that angioplasty and stenting (also known as percutaneous coronary intervention, or PCI) plus the best available medications results in better outcomes than medications alone for patients who have significant blockages in their heart arteries, as measured by fractional flow reserve (FFR).
FAME 2 is an important clinical trial in part because it enrolled consecutive patients with stable coronary artery disease, a patient group whose treatment strategy has been the subject of active debate since the 2007 presentation of COURAGE, which ultimately randomized less than 10 percent of eligible patients. In FAME 2, FFR was performed on every patient to confirm that hemodynamically significant blockages in their coronary arteries were limiting blood flow. The patients with hemodynamically significant blockages were then randomized to PCI plus the best medications available or medications alone.
The results of FAME 2 have been anticipated since earlier this year, when it was announced that an independent safety monitoring board halted the trial early, essentially deeming it unsafe to deny PCI to any study patients whose coronary blockages were found to be significant according to FFR.
Today, the FAME 2 investigators provided further details on the study results:
• Patients who received PCI plus medications were significantly less likely to require an unplanned hospitalization leading to urgent revascularization to stop a heart attack or control symptoms that became unstable; this finding favoring PCI over medications alone emerged within 6 months of randomization.
• The patients treated with PCI plus medications experienced greater symptom relief than those on medications alone.
• The patients who underwent PCI less frequently required treatment with anti-anginal medications compared to those receiving medications alone.
The findings from FAME II are now the best data currently available to inform treatment decisions for patients with stable coronary artery disease. These data clearly demonstrate that the benefit of PCI plus medical therapy in stable patients with ischemia-producing lesions extends beyond symptom relief and quality of life. Unlike COURAGE, the study additionally reflects the current use of evidence-based tests (such as FFR) and modern treatment options (including the use of second-generation drug-eluting stents) and their combined roles in improving patient outcomes. The results of the recently launched and ongoing NIH-funded ISCHEMIA study will provide further clarity when its results are available in approximately 2018.
The Society for Cardiovascular Angiography and Interventions is a 4,000-member professional organization representing invasive and interventional cardiologists in more than 60 nations. SCAI's mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI’s patient and physician education program, Seconds Count, offers comprehensive information about cardiovascular disease. For more information about SCAI and Seconds Count, visit www.scai.org