A Comparison of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Patients With Multivessel Coronary Artery Disease

Prior treatment

• 3\. Recent STEMI (\<5 days prior to randomization)
• 7\. Requiring renal replacement therapy
• 8\. Undergoing evaluation for organ transplantation
• 11\. Inability to take dual antiplatelet therapy for six months
• 12\. Previous CABG
• 15\. Any target lesion with in-stent drug-eluting stent restenosis

Other illness

• 1\. Requirement for other cardiac or non-cardiac surgical procedure (e.g., valve replacement, carotid revascularization)
• 4\. Ongoing Non STEMI with biomarkers (cardiac troponin) still rising
• 13\. Left main disease requiring revascularization

Lab values

• 5\. Known left ventricular ejection fraction \<30%

Age

• 6\. Life expectancy \< 2 years

Other

• 2\. Cardiogenic shock and/or need for mechanical/pharmacologic hemodynamic support
• 9\. Participation or planned participation in another clinical trial, except for observational registries
• 10\. Pregnancy
• 14\. Extremely calcified or tortuous vessels precluding FFR measurement

• 1\. Age ≥ 21 years with angina and/or evidence of myocardial ischemia
• 2\. Three vessel CAD, defined as ≥ 50% diameter stenosis by visual estimation in each of the three major epicardial vessels or major side branches, but not involving left main coronary artery, and amenable to revascularization by both PCI and CABG as determined by the Heart Team. Patients with a non-dominant right coronary artery may be included if only the left anterior descending artery (LAD) and left circumflex have ≥50% stenosis
• 3\. Willing and able to provide informed, written consent