{
    "abstract": "Long-term outcomes following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) might be changing because of improved techniques and better medical therapy. This final prespecified analysis of the Fractional Flow Reserve (FFR) versus Angiography for Multivessel Evaluation (FAME) 3 trial aimed to reassess their comparative effectiveness at 5 years.\nFAME 3 was a multicentre, randomised trial comparing FFR-guided PCI using current-generation zotarolimus-eluting stents versus CABG in patients with three-vessel coronary artery disease not involving the left main coronary artery. 48 hospitals in Europe, USA and Canada, Australia, and Asia participated in the trial. Patients (aged \u226521 years with no cardiogenic shock, no recent ST segment elevation myocardial infarction, no severe left ventricular dysfunction, and no previous CABG) were randomly assigned to either PCI or CABG using a web-based system. At 1 year, FFR-guided PCI did not meet the prespecified threshold for non-inferiority for the outcome of death, stroke, myocardial infarction, or repeat revascularisation versus CABG. The primary endpoint for this intention-to-treat analysis was the 5-year incidence of the prespecified composite outcome of death, stroke, or myocardial infarction. The trial was registered at ClinicalTrials.gov, NCT02100722, and is completed; this is the final report.\nBetween Aug 25, 2014 and Nov 28, 2019, 757 of 1500 participants were assigned to PCI and 743 to CABG. 5-year follow-up was achieved in 724 (96%) patients assigned to PCI and 696 (94%) assigned to CABG. At 5 years, there was no significant difference in the composite of death, stroke, or myocardial infarction between the two groups, with 119 (16%) events in the PCI group and 101 (14%) in the CABG group (hazard ratio 1\u00b716 [95% CI 0\u00b789-1\u00b752]; p=0\u00b727). There were no differences in the rates of death (53 [7%] vs 51 [7%]; 0\u00b799 [0\u00b767-1\u00b746]) or stroke (14 [2%] vs 21 [3%], 0\u00b765 [0\u00b733-1\u00b728]), but myocardial infarction was higher in the PCI group than in the CABG group (60 [8%] vs 38 [5%], 1\u00b757 [1\u00b704-2\u00b736]), as was repeat revascularisation (112 [16%] vs 55 [8%], 2\u00b702 [1\u00b746-2\u00b779]).\nAt the 5-year follow-up, there was no significant difference in a composite outcome of death, stroke, or myocardial infarction after FFR-guided PCI versus CABG, although myocardial infarction and repeat revascularisation were higher with PCI. These results provide contemporary evidence to allow improved shared decision making between physicians and patients.\nMedtronic and Abbott Vascular.",
    "authors": [
        {
            "affiliation": "Department of Medicine, Stanford University, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA; VA Palo Alto Health Care System, Palo Alto, CA, USA. Electronic address: wfearon@stanford.edu.",
            "firstname": "William F",
            "initials": "WF",
            "lastname": "Fearon"
        },
        {
            "affiliation": "St Antonius Hospital, Nieuwegein, Netherlands; Catharina Hospital, Eindhoven, Netherlands.",
            "firstname": "Frederik M",
            "initials": "FM",
            "lastname": "Zimmermann"
        },
        {
            "affiliation": "Quantitative Sciences Unit, Stanford University, Stanford, CA, USA.",
            "firstname": "Victoria Y",
            "initials": "VY",
            "lastname": "Ding"
        },
        {
            "affiliation": "Department of Medicine, Stanford University, Stanford, CA, USA.",
            "firstname": "Kuniaki",
            "initials": "K",
            "lastname": "Takahashi"
        },
        {
            "affiliation": "Gottsegen National Cardiovascular Center, Budapest, Hungary.",
            "firstname": "Zsolt",
            "initials": "Z",
            "lastname": "Piroth"
        },
        {
            "affiliation": "Catharina Hospital, Eindhoven, Netherlands.",
            "firstname": "Albert H M",
            "initials": "AHM",
            "lastname": "van Straten"
        },
        {
            "affiliation": "Gottsegen National Cardiovascular Center, Budapest, Hungary.",
            "firstname": "Laszlo",
            "initials": "L",
            "lastname": "Szekely"
        },
        {
            "affiliation": "Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.",
            "firstname": "Giedrius",
            "initials": "G",
            "lastname": "Davidavi\u010dius"
        },
        {
            "affiliation": "Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.",
            "firstname": "Gintaras",
            "initials": "G",
            "lastname": "Kalinauskas"
        },
        {
            "affiliation": "Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al, Montreal, QC, Canada.",
            "firstname": "Samer",
            "initials": "S",
            "lastname": "Mansour"
        },
        {
            "affiliation": "Oxford University Hospital NHS Trust, Oxford, UK.",
            "firstname": "Rajesh",
            "initials": "R",
            "lastname": "Kharbanda"
        },
        {
            "affiliation": "Danderyd University Hospital and Karolinska Institutet, Solna, Sweden.",
            "firstname": "Nikolaos",
            "initials": "N",
            "lastname": "\u00d6stlund-Papadogeorgos"
        },
        {
            "affiliation": "Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.",
            "firstname": "Adel",
            "initials": "A",
            "lastname": "Aminian"
        },
        {
            "affiliation": "Golden Jubilee National Hospital, Glasgow, UK.",
            "firstname": "Keith G",
            "initials": "KG",
            "lastname": "Oldroyd"
        },
        {
            "affiliation": "Golden Jubilee National Hospital, Glasgow, UK.",
            "firstname": "Nawwar",
            "initials": "N",
            "lastname": "Al-Attar"
        },
        {
            "affiliation": "Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia.",
            "firstname": "Nikola",
            "initials": "N",
            "lastname": "Jagic"
        },
        {
            "affiliation": "Isala Hospital, Zwolle, Netherlands.",
            "firstname": "Jan-Henk E",
            "initials": "JE",
            "lastname": "Dambrink"
        },
        {
            "affiliation": "Medical Faculty of Masaryk University, Brno, Czech Republic; University Hospital Brno, Brno, Czech Republic.",
            "firstname": "Petr",
            "initials": "P",
            "lastname": "Kala"
        },
        {
            "affiliation": "Sahlgrenska University Hospital, Gothenburg, Sweden.",
            "firstname": "Oskar",
            "initials": "O",
            "lastname": "Anger\u00e5s"
        },
        {
            "affiliation": "Kings College Hospital, London, UK.",
            "firstname": "Philip",
            "initials": "P",
            "lastname": "MacCarthy"
        },
        {
            "affiliation": "Cleveland Clinic London, London, UK.",
            "firstname": "Olaf",
            "initials": "O",
            "lastname": "Wendler"
        },
        {
            "affiliation": "Cardiovascular Center Aalst, Aalst, Belgium.",
            "firstname": "Filip",
            "initials": "F",
            "lastname": "Casselman"
        },
        {
            "affiliation": "S\u00f6dersjukhuset Hospital, Stockholm, Sweden; Karolinska Institutet, Solna, Sweden.",
            "firstname": "Nils",
            "initials": "N",
            "lastname": "Witt"
        },
        {
            "affiliation": "Atlanta VA Healthcare System, Decatur, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.",
            "firstname": "Kreton",
            "initials": "K",
            "lastname": "Mavromatis"
        },
        {
            "affiliation": "Southlake Regional Health Centre, Newmarket, ON, Canada.",
            "firstname": "Steven E S",
            "initials": "SES",
            "lastname": "Miner"
        },
        {
            "affiliation": "Wythenshawe Hospital, Manchester, UK.",
            "firstname": "Jaydeep",
            "initials": "J",
            "lastname": "Sarma"
        },
        {
            "affiliation": "Rigshospitalet, Copenhagen, Denmark.",
            "firstname": "Thomas",
            "initials": "T",
            "lastname": "Engstr\u00f8m"
        },
        {
            "affiliation": "Aarhus University Hospital, Aarhus, Denmark.",
            "firstname": "Evald H",
            "initials": "EH",
            "lastname": "Christiansen"
        },
        {
            "affiliation": "Catharina Hospital, Eindhoven, Netherlands.",
            "firstname": "Pim A L",
            "initials": "PAL",
            "lastname": "Tonino"
        },
        {
            "affiliation": "Houston Methodist Hospital, Houston, TX, USA.",
            "firstname": "Michael J",
            "initials": "MJ",
            "lastname": "Reardon"
        },
        {
            "affiliation": "Department of Medicine, Stanford University, Stanford, CA, USA.",
            "firstname": "Hisao",
            "initials": "H",
            "lastname": "Otsuki"
        },
        {
            "affiliation": "NY Presbyterian Brooklyn Methodist Hospital, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.",
            "firstname": "Yuhei",
            "initials": "Y",
            "lastname": "Kobayashi"
        },
        {
            "affiliation": "Department of Health Policy, Stanford University, Stanford, CA, USA; Department of Medicine, Stanford University, Stanford, CA, USA.",
            "firstname": "Mark A",
            "initials": "MA",
            "lastname": "Hlatky"
        },
        {
            "affiliation": "Stanford Center for Clinical Research, Department of Medicine, Stanford University, Stanford, CA, USA.",
            "firstname": "Kenneth W",
            "initials": "KW",
            "lastname": "Mahaffey"
        },
        {
            "affiliation": "Quantitative Sciences Unit, Stanford University, Stanford, CA, USA.",
            "firstname": "Manisha",
            "initials": "M",
            "lastname": "Desai"
        },
        {
            "affiliation": "Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.",
            "firstname": "Y Joseph",
            "initials": "YJ",
            "lastname": "Woo"
        },
        {
            "affiliation": "Department of Medicine, Stanford University, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.",
            "firstname": "Alan C",
            "initials": "AC",
            "lastname": "Yeung"
        },
        {
            "affiliation": "Catharina Hospital, Eindhoven, Netherlands.",
            "firstname": "Nico H J",
            "initials": "NHJ",
            "lastname": "Pijls"
        },
        {
            "affiliation": "Cardiovascular Center Aalst, Aalst, Belgium; Lausanne University Centre Hospital, Lausanne, Switzerland.",
            "firstname": "Bernard",
            "initials": "B",
            "lastname": "De Bruyne"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2025 Published by Elsevier Ltd.",
    "doi": "10.1016/S0140-6736(25)00505-7",
    "journal": "Lancet (London, England)",
    "keywords": [],
    "methods": null,
    "publication_date": "2025-04-03",
    "pubmed_id": "40174598",
    "results": null,
    "title": "Outcomes after fractional flow reserve-guided percutaneous coronary intervention versus coronary artery bypass grafting (FAME 3): 5-year follow-up of a multicentre, open-label, randomised trial.",
    "xml": "<Element 'PubmedArticle' at 0x788503cdaf70>"
}