title: The impact of age on fractional flow reserve-guided percutaneous coronary intervention: a FAME (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) trial substudy.
abstract: BACKGROUND
  Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) improved outcomes compared with an angiography-guided strategy in patients with multivessel coronary artery disease (CAD). However, the effect of age on FFR has not been well-studied. We aimed to evaluate the impact of age on the favorable results of routine FFR-guided PCI for multivessel CAD.
  
  
  METHODS
  We compared 1 year outcomes between FFR-guided PCI and angiography-guided PCI in the 512 patients enrolled in the FAME study <65 years old compared to the 493 patients ≥ 65 years old. We also evaluated the effect of age on the FFR result of varying degrees of visually estimated coronary stenosis.
  
  
  RESULTS
  The 1-year rate of death, myocardial infarction or repeat revascularization in the angiography-guided group tended to be higher than in the FFR-guided group for both those patients <65 (17.2% vs. 12.0%, P = 0.098) and those ≥ 65 years old (19.7% vs. 14.3%, P = 0.111) with no significant interaction based on age (P = 0.920). Older patients had higher FFR in vessels with 50% to 70% stenosis (0.83 ± 0.11 vs. 0.80 ± 0.13, P = 0.028) and in vessels with 71% to 90% stenosis (0.69 ± 0.15 vs. 0.65 ± 0.16, P = 0.002). The proportion of functionally significant lesions (FFR ≤ 0.80) in vessels with 71% to 90% stenosis was significantly lower in elderly compared to younger patients (75.3% vs. 84.1%, P = 0.013).
  
  
  CONCLUSIONS
  FFR-guided PCI is beneficial regardless of age, however, older patients have fewer functionally significant lesions, despite a similar angiographic appearance.
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States; Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Hong-Seok
authors.initials: HS
authors.lastname: Lim
authors.affiliation: Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Pim A L
authors.initials: PA
authors.lastname: Tonino
authors.affiliation: Cardiovascular Center, Aalst, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States.
authors.forename: Andy S C
authors.initials: AS
authors.lastname: Yong
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States; Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
authors.forename: Bong-Ki
authors.initials: BK
authors.lastname: Lee
authors.affiliation: Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Nico H J
authors.initials: NH
authors.lastname: Pijls
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States. Electronic address: wfearon@stanford.edu.
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aging; Fractional flow reserve; Percutaneous coronary intervention