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December 7, 2010 -- 4:55pm EST

Fractional Flow Reserve and Stents
FAMEous interventional cardiologist William Fearon of Stanford sat down with Angioplasty.Org recently to talk about a better way to judge if a patient might benefit from a stent. Instead of looking at the x-ray angiogram and saying, "That's a 70% blockage -- let's put a stent in there and you'll feel much better," Dr. Fearon advocates the use of a thin pressure wire which actually measures the flow through the narrowing. The technology is called Fractional Flow Reserve or FFR.

Turns out that sometimes what looks like a blockage on the x-ray isn't always restricting the flow enough to cause ischemia (reduced oxygen to the heart muscle which usually, but not always, results in angina). And vice-versa, sometimes ischemia/angina is being caused by an area that doesn't look so bad on the angiogram.

You can read all about FAME, the ground-breaking study that Dr. Fearon was involved in, and also the two-year results -- but the bottom line is that FFR resulted in one-third fewer stents being used, and one-third fewer heart attacks and deaths.

As I mentioned yesterday, these findings have a direct relevance to the "Midei in Maryland" firestorm that has erupted over the accusations in the 172-page Senate Finance Committee Staff Report on the overuse of cardiac stents.

So you ask, why wasn't Midei using FFR to make these decisions? Well, number one -- the FAME study wasn't published until January 2009, after most of this "alleged unnecessary stenting" had been done and, number two, even today only 15% of labs use this technology. Actually there's a number three: Dr. Midei's hospital, St. Joseph's Medical Center, accused him of failing to use FFR but, according to an article on theheart.org, Midei counter-claimed that:

FYI, Fractional Flow Reserve (FFR) pressure wires are manufactured by two companies: Volcano Corporation and St. Jude Medical.

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