{"id":6996,"date":"2025-05-22T12:52:19","date_gmt":"2025-05-22T09:52:19","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=6996"},"modified":"2025-05-22T12:52:19","modified_gmt":"2025-05-22T09:52:19","slug":"article-summary-cabg-still-superior-to-stents-despite-fame-3-endpoint-swap","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/article-summary-cabg-still-superior-to-stents-despite-fame-3-endpoint-swap\/","title":{"rendered":"Article summary : \u201cCABG Still Superior to Stents Despite FAME 3 Endpoint Swap\u201d"},"content":{"rendered":"
Article summary :<\/div>\n
\u201cCABG Still Superior to Stents Despite FAME 3 Endpoint Swap\u201d<\/div>\n
By: John M. Mandrola, MD<\/div>\n
Published: May 6, 2025<\/div>\n
Source: Medscape Commentary<\/div>\n
<\/div>\n
Key Summary Points<\/div>\n
<\/div>\n
1. Background \u2013 The FAME 3 Trial<\/div>\n
\u2022 FAME 3 compared FFR-guided PCI vs CABG in patients with multivessel coronary artery disease (CAD).<\/span><\/div>\n
\u2022 It followed three prior trials (SYNTAX, FREEDOM, BEST) that had consistently shown CABG superiority.<\/span><\/div>\n
<\/div>\n
2. 1-Year Results (Original Primary Endpoint)<\/div>\n
\u2022 Composite outcome (death, MI, stroke, revascularization):<\/span><\/div>\n
\u2022 PCI: 10.6% vs CABG: 6.9%.<\/span><\/div>\n
\u2022 HR = 1.5, 95% CI: 1.1\u20132.2 \u2013 not noninferior.<\/span><\/div>\n
\u2022 Conclusion: CABG superior to PCI.<\/span><\/div>\n
\u2022 Editorial titled: \u201cCABG vs PCI \u2014 End of the Debate?\u201d<\/span><\/div>\n
<\/div>\n
3. 3-Year Results \u2013 Endpoint Change Introduced<\/div>\n
\u2022 New composite endpoint used: death, MI, stroke (excluded revascularization).<\/span><\/div>\n
\u2022 Result: No significant difference (12% PCI vs 9.2% CABG; HR = 1.3; P = 0.07).<\/span><\/div>\n
\u2022 Original endpoint would still show CABG as superior:<\/span><\/div>\n
\u2022 18.6% PCI vs 12.5% CABG; HR = 1.5, P = 0.002.<\/span><\/div>\n
<\/div>\n
4. 5-Year Results \u2013 Continued with Revised Endpoint<\/div>\n
\u2022 Death, MI, stroke:<\/span><\/div>\n
\u2022 16% PCI vs 14.1% CABG; HR = 1.16, P = 0.27 (NS).<\/span><\/div>\n
\u2022 If original endpoint used:<\/span><\/div>\n
\u2022 25% PCI vs 18% CABG; HR = 1.44, P = 0.002.<\/span><\/div>\n
\u2022 MI and revascularization rates still higher after PCI.<\/span><\/div>\n
<\/div>\n
5. Concerns Over the Endpoint Change<\/div>\n
\u2022 The change undermines trial integrity and masks clear benefit of CABG.<\/span><\/div>\n
\u2022 Three core objections:<\/span><\/div>\n
1. Repeat revascularization is clinically meaningful, linked to higher mortality.<\/span><\/div>\n
2. Changing endpoints mid-study undermines scientific rigor.<\/span><\/div>\n
3. The new endpoint had wide confidence intervals and wasn\u2019t powered or adjusted for multiple comparisons.<\/span><\/div>\n
<\/div>\n
6. Public Messaging & Misleading Interpretation<\/div>\n
\u2022 ACC 2025 headlines and press releases wrongly framed PCI as equal to CABG.<\/span><\/div>\n
\u2022 This contradicts the data when using the original, more comprehensive endpoint.<\/span><\/div>\n
<\/div>\n
7. Author\u2019s Conclusion<\/div>\n
\u2022 CABG remains superior for patients with multivessel CAD.<\/span><\/div>\n
\u2022 The real change was in presentation, not outcomes.<\/span><\/div>\n
\u2022 FAME 3 supports findings of earlier trials \u2013 PCI still carries higher event rates long-term.<\/span><\/div>\n
Link: Medscape article :https:\/\/click.mail.medscape.com\/?qs=3900ddeba56641e3de68dd04a7c5cc1fab425551acf4fc1181ddcde4448be1ba33a124f9884d02f1efc8c0072431efd314d2e4bd9e7e7665af3d80f6f7a86cb3<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

Article summary : \u201cCABG Still Superior to Stents Despite FAME 3 Endpoint Swap\u201d By: John M. Mandrola, MD Published: May 6, 2025 Source: Medscape Commentary Key Summary Points 1. Background \u2013 The FAME 3 Trial \u2022 FAME 3 compared FFR-guided PCI vs CABG in patients with multivessel coronary artery disease (CAD). \u2022 It followed three […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-6996","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/6996","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=6996"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/6996\/revisions"}],"predecessor-version":[{"id":6998,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/6996\/revisions\/6998"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=6996"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=6996"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=6996"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}