ASYMPTOMATIC PATIENTS WITH AT LEAST ONE NARROWED VESSEL ARE BETTER WITH DRUG THERAPY AND STENT THEN DRUG THERAPY ALONE

The San Francisco Chronicle (8/29, Allday, Lee, Colliver) reports, "Patients who are asymptomatic but have at least one narrowed blood vessel that severely lowers blood flow to the heart are better off being treated with drugs and a stent placed in the artery than with drug therapy alone, according to results of a large trial" published online Aug. 28 in the New England Journal of Medicine.

        HealthDay (8/29, Mann) reports that for "the new study, researchers used a diagnostic tool called fractional flow reserve (FFR) to help determine the best course of treatment among more than 1,200 people with stable heart disease." The research "was stopped early due to high rates of hospitalization and urgent need for stenting seen among people who only received drug therapy...initially."

        The Minneapolis Star Tribune (8/29, Walsh) reports that Dr. Bernard De Bruyne, the coordinating clinical investigator of the FAME II Trial, said, "With this new knowledge, I believe that FFR should become the standard of care for treating patients with stable coronary artery disease and significant coronary narrowings."

        On its website, ABC (8/29) reports, "However, the new study is unlikely to end the debate over the use of stents, which has raged since a landmark study in 2007 known as the COURAGE trial."

        MedPage Today (8/29, Neale) reports, "Spencer King III, MD, professor emeritus at Emory University and a past president of the American College of Cardiology, said that there would be some criticisms about the study regarding the inclusion of urgent revascularization - often considered a 'soft' outcome - in the primary composite endpoint with the hard outcomes of death and MI."

        WebMD (8/29, Laino) reports, "Fractional flow reserve is available at most medical centers. And It's being used more and more to help determine the best course of treatment for opening narrowed arteries, says American College of Cardiology immediate past president David Holmes, MD."

        CardioSource (8/29) reports "A couple of limitations warrant mention. The mean follow-up was very short-approximately 7 months. Thus, it was too short to study meaningful differences in hard endpoints such as death or MI, and also for assessing the impact of restenosis in the PCI arm. Thus, it will remain a point of discussion that the Data Safety Monitoring Board terminated this trial early based on differences in unplanned revascularization between the two arms, since rates of death and MI were similar. The practicality and cost-effectiveness of FFR-guided PCI for every stable angina lesion will need to be further studied.

Steven Almany M.D.