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Peer-reviewedCC BYJACC. Advances

Long-Term Clinical Outcomes After Physiology-Guided vs Angiography-Guided Coronary Artery Bypass Grafting: From the FARGO Trial.

  • Jens Trøan1
  • Anne Langhoff Thuesen2
  • Evald Høj Christiansen3
  • Ashkan Eftekhari4
  • Ole Havndrup5
  • Ivy Susanne Modrau6
  • Lars Peter Riber2
  • Jan Jesper Andreasen7
  • Svend Eggert Jensen4
  • Joachim Dahl Steensbjerre8
  • Julie Juul Siig4
  • Yusuf Abdi Isse5
4 more authors
  • Anders Junker9
  • Poul Erik Mortensen2
  • William F Fearon10
  • Lisette Okkels Jensen9
10 affiliations
  1. 1Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: [email protected].
  2. 2Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
  3. 3Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
  4. 4Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
  5. 5Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
  6. 6Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
  7. 7Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.
  8. 8Department of Cardiology, Odense University Hospital, Odense, Denmark; DaCHE, Department of Public Health, University of Southern Denmark, Odense, Denmark.
  9. 9Department of Cardiology, Odense University Hospital, Odense, Denmark.
  10. 10Department of Medicine, Stanford University, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; VA Palo Alto Health Care System, Palo Alto, California, USA.
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Abstract

Background

Fractional flow reserve (FFR)-guided coronary artery bypass grafting (CABG) may reduce unnecessary grafts and improve outcomes. However, in the FARGO (Fractional Flow Reserve vs Angiography Randomization for Graft Optimization) trial, FFR was reduced significantly after 6 months in deferred lesions.Objectives

The purpose of this study was to evaluate long-term clinical outcomes after FFR-guided CABG compared to angiography-guided CABG.Methods

In this multicenter randomized clinical trial, 100 patients were randomized to FFR-guided (n = 50) or angiography-guided CABG (n = 50). Patients underwent a 6-month follow-up coronary angiography with FFR in deferred lesions. In this extended long-term follow-up revascularization, myocardial infarction, stroke, death, and major adverse cardiac and cerebrovascular events (MACCE), a composite of the individual endpoints, were assessed.Results

After a median follow-up of 8.8 years (IQR: 8.3, 9.3), patients in the FFR-guided group had significantly more MACCE compared to the angiography-guided group, (26 [52%] vs 16 [32%], log-rank test P = 0.03). This difference was driven by significantly more long-term revascularization, FFR-guided CABG 32% vs angiography-guided 12%, log-rank test P = 0.01. The revascularization rate was significantly higher from 0 to 1 year (12 [24%] vs 3 [6%], log-rank test P = 0.01), whereas beyond 1 year, rates were similar (4 [8%] vs 3 [6%], log-rank test P = 0.47). Most patients had stable symptoms, and revascularization was symptom-driven. Myocardial infarction (6 [12%] vs 3 [6%]), death (10 [20%] vs 7 [14%]), and stroke (6 [12%] vs 6 [12%]) did not differ significantly between the groups.Conclusions

FFR-guided CABG was associated with a significantly higher rate of MACCE after CABG, driven by more revascularization within the first year.

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Cite

BibTeXRIS
BibTeX
@article{troan2026longterm,
  title = {{Long-Term Clinical Outcomes After Physiology-Guided vs Angiography-Guided Coronary Artery Bypass Grafting: From the FARGO Trial.}},
  author = {Jens Trøan and Anne Langhoff Thuesen and Evald Høj Christiansen and Ashkan Eftekhari and Ole Havndrup and Ivy Susanne Modrau and Lars Peter Riber and Jan Jesper Andreasen and Svend Eggert Jensen and Joachim Dahl Steensbjerre and Julie Juul Siig and Yusuf Abdi Isse and Anders Junker and Poul Erik Mortensen and William F Fearon and Lisette Okkels Jensen},
  journal = {JACC. Advances},
  year = {2026},
  month = sep,
  doi = {10.1016/j.jacadv.2026.103332},
  url = {https://europepmc.org/article/MED/42868963},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Long-Term Clinical Outcomes After Physiology-Guided vs Angiography-Guided Coronary Artery Bypass Grafting: From the FARGO Trial.
AU  - Jens Trøan
AU  - Anne Langhoff Thuesen
AU  - Evald Høj Christiansen
AU  - Ashkan Eftekhari
AU  - Ole Havndrup
AU  - Ivy Susanne Modrau
AU  - Lars Peter Riber
AU  - Jan Jesper Andreasen
AU  - Svend Eggert Jensen
AU  - Joachim Dahl Steensbjerre
AU  - Julie Juul Siig
AU  - Yusuf Abdi Isse
AU  - Anders Junker
AU  - Poul Erik Mortensen
AU  - William F Fearon
AU  - Lisette Okkels Jensen
PY  - 2026
DA  - 2026/09/22
JO  - JACC. Advances
DO  - 10.1016/j.jacadv.2026.103332
UR  - https://europepmc.org/article/MED/42868963
AB  - Background  Fractional flow reserve (FFR)-guided coronary artery bypass grafting (CABG) may reduce unnecessary grafts and improve outcomes. However, in the FARGO (Fractional Flow Reserve vs Angiography Randomization for Graft Optimization) trial, FFR was reduced significantly after 6 months in deferred lesions.Objectives  The purpose of this study was to evaluate long-term clinical outcomes after FFR-guided CABG compared to angiography-guided CABG.Methods  In this multicenter randomized clinical trial, 100 patients were randomized to FFR-guided (n = 50) or angiography-guided CABG (n = 50). Patients underwent a 6-month follow-up coronary angiography with FFR in deferred lesions. In this extended long-term follow-up revascularization, myocardial infarction, stroke, death, and major adverse cardiac and cerebrovascular events (MACCE), a composite of the individual endpoints, were assessed.Results  After a median follow-up of 8.8 years (IQR: 8.3, 9.3), patients in the FFR-guided group had significantly more MACCE compared to the angiography-guided group, (26 [52%] vs 16 [32%], log-rank test P = 0.03). This difference was driven by significantly more long-term revascularization, FFR-guided CABG 32% vs angiography-guided 12%, log-rank test P = 0.01. The revascularization rate was significantly higher from 0 to 1 year (12 [24%] vs 3 [6%], log-rank test P = 0.01), whereas beyond 1 year, rates were similar (4 [8%] vs 3 [6%], log-rank test P = 0.47). Most patients had stable symptoms, and revascularization was symptom-driven. Myocardial infarction (6 [12%] vs 3 [6%]), death (10 [20%] vs 7 [14%]), and stroke (6 [12%] vs 6 [12%]) did not differ significantly between the groups.Conclusions  FFR-guided CABG was associated with a significantly higher rate of MACCE after CABG, driven by more revascularization within the first year.
SN  - 2772-963X
ER  -