Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (F.A.M.E.)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00267774
Recruitment Status : Completed
First Posted : December 21, 2005
Results First Posted : July 27, 2016
Last Update Posted : November 13, 2017
Information provided by (Responsible Party):
William Fearon, Stanford University

Brief Summary:
In this multicenter, international study we are evaluating two approaches to determine which coronary artery narrowings require stent placement in patients with multivessel coronary artery disease. Patients will be randomized to an angiographic strategy, where only coronary angiography is used to determine which lesions to stent or to a pressure wire strategy where fractional flow reserve, an index measured with the pressure wire, will be used to determine which lesions to stent. The primary outcome will be major adverse cardiac events at 1 year. A secondary outcome will be cost-effectiveness.

Condition or disease Intervention/treatment Phase
Coronary Arteriosclerosis Device: Fractional flow reserve Procedure: Angio-guided PCI Not Applicable

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Detailed Description:

Detailed protocol

  • If a patient is eligible for the study (see inclusion and exclusion criteria) and has given informed consent, the operator has to define all lesions with a stenosis severity of at least 50% by visual estimate in which he would consider stent implantation. These stenoses are noted on a scheme of the coronary arteries before randomization.
  • Thereafter, randomization is performed to the FFR-guided strategy or the angiography-guided strategy. If the patient is randomized to the angiography-guided strategy, all the lesions indicated beforehand, will be stented with drug-eluting stents. If the patient is assigned to the FFR-guided group, fractional flow reserve is measured in all lesions and only those lesions are stented with a fractional flow reserve </=0.80. Treatment after PCI is according to local routine and should include at least aspirin 80 mg daily and clopidogrel (Plavix) 75 mg per day for at least 12months.
  • FFR should be determined by using i.v. adenosine 140 µg/kg/min, in order to make pull-back recordings and analyze different abnormalities along the coronary arteries. Adenosine i.v. by the femoral venous route, is mandatory for participation in the study.
  • In case of serial stenosis, FFR 'of the complete vessel' should be </= 0.80 to warrant PCI of one of more of these lesions in case the patient belongs to the FFR-guided group. In case of the angio-guided group, every lesion >50% by visual estimation that the operator indicated a prior as requiring stenting, should be stented (this is mandatory). Long stents to cover a segment or multiple shorter stents, can be placed at the discretion of the operator.


All patients will be followed up after 1 month (±1 week), 6 months (±1 month), and 1 year (±1 month). All adverse cardiac events (death, acute MI, CABG or [re]-PCI will be noted, as well as functional class and number of anti-anginal drugs. If a patient is admitted to a hospital because of an acute coronary syndrome, repeat angiography is strongly advocated to define if the event is related to one of the deferred lesions or to one of the non-deferred lesions. If the patient belongs to the FFR-guided arm, repeat measurement of FFR is advocated for all lesions. If, during follow-up, patients in the FFR-guided group have to undergo coronary angiography because of recurrent angina or any other reason without an event, pressure measurement should be repeated as well.

On the contrary, once a patient has been assigned to the angiographic guided group, this strategy should be followed consistently during follow-up investigations. For example, if a patient in the angiographic guided arm has recurrent chest pain, undergoes angiography, and is found to have in-stent restenosis, re-PCI should be performed based on the angiogram and pressure wire use is prohibited.

In other words, the strategy to which the patient has been assigned initially, should be followed during the entire study period.


Primary endpoints

1. The primary clinical endpoint is the 12-month binary major adverse cardiac event (MACE) rate. MACE is defined as:

  • All cause death,
  • Documented myocardial infarction,
  • Repeat revascularization (PCI and/or CABG) as adjudicated by the Clinical Event Committee

Secondary endpoints

  1. Global cost effectiveness after one year
  2. Cardiac death and myocardial infarction rate at 1 year
  3. Functional class at 1 year.
  4. Number of anti-anginal drugs after 1 year
  5. Overall MACE rate at 1 month post-procedure and at 6 months, 2, 3 and 5 years.
  6. A comparison of outcomes based on type of drug-eluting stent.
  7. Prognostic value of FFR after stenting.
  8. Correlation between FFR and nuclear perfusion imaging.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1005 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Study Start Date : January 2006
Actual Primary Completion Date : September 2008
Actual Study Completion Date : September 2015

Arm Intervention/treatment
Experimental: FFR guided PCI Device: Fractional flow reserve
Active Comparator: Angio-guided PCI Procedure: Angio-guided PCI

Primary Outcome Measures :
  1. Major Adverse Cardiac Events [ Time Frame: 1 year ]
    All cause death, Documented myocardial infarction, Repeat revascularization (PCI and/or CABG) as adjudicated by the Clinical Event Committee

Secondary Outcome Measures :
  1. Cost Effectiveness Measured as Index Procedural and Hospitalization Costs [ Time Frame: 1 year ]
    Costs for each strategy included the initial procedural costs and costs during the 1-year follow-up. The costs of the index procedures were calculated from the actual resource consumption by determining the amount of guiding catheters, regular wires, pressure wires, balloon dilatation catheters, stents, antiplatelet therapy, adenosine, contrast media, and hospital days used for each patient's index procedure. These were multiplied by the cost of each resource in US dollars. All costs were converted to 2008 US dollars using the consumer price index (

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:- at least 2 coronary lesions of 50% stenosis or greater in at least 2 major epicardial arteries

  • age>/=18

Exclusion Criteria:-- STEMI < 5 days ago or non-STEMI with CK > 1000 U/l < 5 days ago

  • Pregnancy
  • Extremely tortuous or calcified coronary arteries, or other technical conditions interfering with reliable coronary pressure measurement
  • Serious concomitant disease, decreasing life expectancy to <2 years
  • Previous coronary bypass surgery (CABG)
  • Contraindication for drug-eluting stent
  • Cardiogenic shock
  • Inability to give informed consent
  • Suspicion of significant left main (LM) stenosis

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00267774

United States, California
Stanford University School of Medicine
Stanford, California, United States, 94305
Catharina Hospital
Eindhoven, Netherlands
Sponsors and Collaborators
Stanford University
Principal Investigator: Nico H Pijls Catharina Ziekenhuis Eindhoven
Principal Investigator: William F Fearon Stanford University

Publications of Results:
Publications automatically indexed to this study by Identifier (NCT Number):

Responsible Party: William Fearon, Principle Investigator, Stanford University Identifier: NCT00267774     History of Changes
Other Study ID Numbers: 3933
First Posted: December 21, 2005    Key Record Dates
Results First Posted: July 27, 2016
Last Update Posted: November 13, 2017
Last Verified: October 2017

Additional relevant MeSH terms:
Coronary Artery Disease
Myocardial Ischemia
Arterial Occlusive Diseases
Vascular Diseases
Cardiovascular Diseases
Coronary Disease
Heart Diseases