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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, 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.

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

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