FFR-Guided PCI VS CABG for Multivessel Coronary Artery Disease: Lessons from FAME 3

Take Home Messages
  • FAME 3 is a randomised controlled trial which compared FFR-guided PCI to CABG for multi vessel coronary artery disease.
  • FFR-guided PCI failed to achieve non-inferiority to CABG surgery in managing multivessel CAD (primary endpoint was major adverse cardiac and cerebrovascular events).
  • The previous FAME trial proved that FFR-guided PCI was associated with better outcomes compared to angiography-guided PCI in management of multivessel CAD.
  • The study limitations include a short follow-up period, lack of diversity (in terms of sex and ethnicity), exclusion of patients with acute MI, and limited use of other modalities like IVUS which can improve precision and outcomes of PCI in general.


Fractional flow reserve (FFR) has now become widely used in percutaneous coronary intervention (PCI) as it gives more accurate information about the physiological significance of the coronary lesions (1). Studied in the Fractional Flow Reserve V ersus Angiography for Multivessel Evaluation (FAME) trial (2), FFR-guided PCI was proven to have better outcomes than angiography-guided PCI for managing multivessel coronary artery disease (CAD) (2). Subsequently, the FAME 3 trial was conducted to assess the non-inferiority of FFR- guided PCI to coronary artery bypass graft (CABG) surgery in the management of multivessel CAD (3).