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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:
...he was the one who had fought SJMC "tooth
and nail" to purchase the FFR technology, and while he ultimately
was successful, the center's FFR program was not even up and
running the day he was discharged.
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FYI, Fractional Flow Reserve (FFR) pressure wires are
manufactured by two companies: Volcano
Corporation and St. Jude Medical.
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