{"id":"f2e9c6056314","type":"article","url":"https://hartvaat.nl/2025/06/01/ffr-geleide-pci-versus-cabg-bij-diffuus-coronairlijden/","title":"FFR-geleide PCI versus CABG bij diffuus coronairlijden","title_en":"FFR-Guided Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Diabetes.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2025.0095","source_url":"https://doi.org/10.1001/jamacardio.2025.0095","authors":["Kuniaki Takahashi","Hisao Otsuki","Frederik M Zimmermann","Victoria Y Ding","Thomas Engstrøm","Hans Gustav Hørsted Thyregod","Branko Beleslin","Svetozar Putnik","Luke Tapp","Thomas Barker","Simon Redwood","Christopher Young","G Jan-Willem Bech","Gerard J F Hoohenkerk","Bernard De Bruyne","Nico H J Pijls","William F Fearon"],"significance":6,"published":"2025-06-01","source_date":"2025-06-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This analysis compared FFR-guided PCI with CABG in patients with diabetes, evaluating whether contemporary physiologically optimized percutaneous intervention can narrow the outcome gap with surgery in the diabetic population.","created":"2026-07-03T10:31:39Z","updated":"2026-07-03T13:30:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse vergeleek FFR-geleide PCI met CABG bij diffuus coronairlijden. De resultaten informeren de revascularisatiekeuze bij anatomisch uitdagende ziektepatronen.","abstract_original":"IMPORTANCE: Outcomes in patients with diabetes after fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) using current-generation drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) are unknown. OBJECTIVES: To investigate the relative treatment effect of PCI vs CABG according to diabetes status with respect to major adverse cardiac and cerebrovascular events (MACCE) at 3 years and to evaluate the impact of the SYNTAX score. DESIGN, SETTING, AND PARTICIPANTS: This is a prespecified subgroup analysis of the FAME (Fractional Flow Reserve vs Angiography for Multivessel Evaluation) 3 trial, an investigator-initiated, randomized clinical trial conducted at 48 centers worldwide. The FAME 3 trial enrolled patients with 3-vessel coronary artery disease not involving the left main undergoing coronary revascularization between August 2014 and December 2019. Data analysis was conducted in August 2023. Clinical follow-up was performed at hospital discharge and at 1 month, 6 months, 1 year, 2 years, and 3 years after randomization. INTERVENTION: Either FFR-guided PCI with current-generation DES or CABG. MAIN OUTCOMES AND MEASURES: The primary end point was MACCE, defined as the composite of all-cause death, myocardial infarction, stroke, or repeat revascularization at 3 years. RESULTS: Of 1500 total patients enrolled, mean (SD) patient age was 65.1 (8.4) years, and 265 patients (17.7%) were female. The FAME 3 trial included 428 patients with diabetes (28.5%). Patients with diabetes, especially those receiving insulin, had a higher risk of MACCE at 3 years compared with those without diabetes. Regarding relative treatment effect, the risk of MACCE was higher after FFR-guided PCI compared with CABG in both patients with diabetes (hazard ratio [HR], 1.44; 95% CI, 0.91-2.28; P = .12) and those without diabetes (HR, 1.50; 95% CI, 1.08-2.07; P = .02), with no significant interaction (P for interaction = .94). In patients with a low SYNTAX score (<23), there was no significant difference in MACCE between PCI and CABG, while in patients with an intermediate to high SYNTAX score (≥23), PCI had a higher risk of MACCE than CABG, regardless of diabetes status. CONCLUSIONS AND RELEVANCE: In this subgroup analysis of the FAME 3 randomized clinical trial, the relative benefit of CABG compared with FFR-guided PCI was similar among patients with and without diabetes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02100722."}