Fearon WF, Zimmermann FM, De Bruyne B, et al. - Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for three-vessel coronary artery disease was not identified to be noninferior to coronary-artery bypass grafting (CABG) regarding the incidence of a composite of death, myocardial infarction, stroke, or repeat revascularization at 1 year.

• A multicenter, international, noninferiority trial in which 1500 patients with three-vessel coronary artery disease were randomized to receive CABG or FFR-guided PCI with current-generation zotarolimus-eluting stents.

• The primary endpoint was defined as within 1 year occurrence of a major adverse cardiac or cerebrovascular event, defined as death from any cause, myocardial infarction, stroke, or repeat revascularization.

• In the FFR-guided PCI group, the 1-year incidence of the composite primary endpoint was 10.6%; it was 6.9% in those who underwent CABG (hazard ratio, 1.5), results that were not consistent with noninferiority of FFR-guided PCI (P=0.35 for noninferiority).

• In the FFR-guided PCI group and in the CABG group, the incidence of death, myocardial infarction, or stroke was 7.3% and 5.2%, respectively (hazard ratio, 1.4).

• The CABG group showed higher incidences of major bleeding, arrhythmia, and acute kidney injury, vs the FFR-guided PCI group.