Sep 16, 2026 · 9 min · 8 segments
William Fearon and C. Michael Gibson break down the final 5-year follow-up of the study comparing FFR-guided PCI vs CABG for patients with three-vessel CAD.
William FearonGuest
C. Michael GibsonHostMike Gibson, Bill Farron, and we're talking about the five-year results comparing angiographic or FFR-guided, rather, PCI versus CABG.
And just as a reminder about what FAME3 was, when we think of multivessel disease and revascularization strategies, the kind of divide it into two groups, left main patients or patients with three vessel disease not involving the left main.
And we have some fairly contemporary data in the left main space with Accel and Noble.
But in the three-vessel disease not involving left main, sort of the granddaddy is the syntax trial.
And so that was the goal of the FAME-3 trial, to look at contemporary PCI using FFR, current generation DES, comparing it with contemporary surgical techniques and current guideline-directed medical therapy.
The goal initially was to compare it to the syntax trial, and so we used the same primary endpoint, which was one-year death, stroke, MI, or repeat revascularization.
But when we planned it, we realized that a lot of people don't think repeat revascularization is as relevant an endpoint as it once was.
We had a pre-specified key secondary endpoint at three years, and then a funding allowed also at five years, and subsequently funding came through.
The p-value is 0.07. And as we know from trials like SYNTAX, Previously, at least, CABG tends to accrue benefit over time.
And so that was the goal of FAME III was to look at five-year outcomes, hard endpoints, death, stroke, or MI between FFR-guided PCI and CABG.
Mike Gibson, Bill Farron, and we're talking about the five-year results comparing angiographic or FFR-guided, rather, PCI versus CABG.
And just as a reminder about what FAME3 was, when we think of multivessel disease and revascularization strategies, the kind of divide it into two groups, left main patients or patients with three vessel disease not involving the left main.
And we have some fairly contemporary data in the left main space with Accel and Noble.
But in the three-vessel disease not involving left main, sort of the granddaddy is the syntax trial.
And so that was the goal of the FAME-3 trial, to look at contemporary PCI using FFR, current generation DES, comparing it with contemporary surgical techniques and current guideline-directed medical therapy.
The goal initially was to compare it to the syntax trial, and so we used the same primary endpoint, which was one-year death, stroke, MI, or repeat revascularization.
But when we planned it, we realized that a lot of people don't think repeat revascularization is as relevant an endpoint as it once was.
We had a pre-specified key secondary endpoint at three years, and then a funding allowed also at five years, and subsequently funding came through.
The p-value is 0.07. And as we know from trials like SYNTAX, Previously, at least, CABG tends to accrue benefit over time.
And so that was the goal of FAME III was to look at five-year outcomes, hard endpoints, death, stroke, or MI between FFR-guided PCI and CABG.
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