Contemporary state-of-the-art PCI with functional and imaging concepts: forethoughts on the FAME 3 trial.

Abstract

As compared with bare metal stents, the use of drug-eluting stents (DES) has been associated with a significant reduction of angiographic and clinical restenosis and has become the default device in the contemporary practice of percutaneous coronary intervention (PCI). However, despite a remarkable improvement in PCI efficacy with DES, coronary artery bypass grafting (CABG) is still the preferred revascularisation strategy for patients with multivessel coronary artery disease (CAD), particularly those with diabetes and higher anatomic complexity1. Over the last decade, advances in DES technology, technical refinement, and adjunctive antithrombotic therapy have led to progressively improved PCI outcomes for complex CAD. In addition, there has been an evolution in invasive techniques that allow detailed assessment of both function and anatomy, which facilitates integrated use of fractional flow reserve (FFR) and intravascular ultrasound (IVUS) as adjunctive tools in complex PCI2. The angiographic SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score is a parameter to reflect the anatomic complexity and has a key role in decision making for optimal revascularisation in multivessel CAD3. Besides, PCI has substantially evolved since completion of the SYNTAX trial, in which the first-generation DES was used and the disease severity was assessed according to the angiographic assessment alone. Until recently, the long-term clinical effect of the most up-to-date contemporary PCI concept (i.e., decision making with more comprehensive risk assessment including anatomic and clinical factors, physiology guidance for PCI appropriateness, imaging guidance for PCI optimisation, and smarter DES and adjunctive drugs) has been lacking. In this issue of EuroIntervention, this issue is addressed by Serruys and colleagues, who performed a two-year follow-up of the SYNTAX II study4.