Author(s): Pijls NH, van Schaardenburgh P, Manoharan G, Boersma E, Bech JW,
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Abstract OBJECTIVES: The purpose of this study was to investigate the appropriateness of stenting a functionally nonsignificant stenosis. BACKGROUND: Percutaneous coronary intervention (PCI) of an intermediate stenosis without evidence of ischemia is often performed, but its benefit is unproven. Coronary pressure-derived fractional flow reserve (FFR) is an invasive index used to identify a stenosis responsible for reversible ischemia. METHODS: In 325 patients scheduled for PCI of an intermediate stenosis, FFR was measured just before the planned intervention. If FFR was >or =0.75, patients were randomly assigned to deferral (Defer group; n = 91) or performance (Perform group; n = 90) of PCI. If FFR was <0.75, PCI was performed as planned (Reference group; n = 144). Clinical follow-up was 5 years. RESULTS: There were no differences in baseline clinical characteristics between the 3 groups. Complete follow-up was obtained in 98\% of the patients. Event-free survival was not different between the Defer and Perform groups (80\% and 73\%, respectively; p = 0.52), but was significantly worse in the Reference group (63\%; p = 0.03). The composite rate of cardiac death and acute myocardial infarction in the Defer, Perform, and Reference groups was 3.3\%, 7.9\%, and 15.7\%, respectively (p = 0.21 for Defer vs. Perform group; p = 0.003 for the Reference vs. both other groups). The percentage of patients free from chest pain at follow-up was not different between the Defer and Perform groups. CONCLUSIONS: Five-year outcome after deferral of PCI of an intermediate coronary stenosis based on FFR >/=0.75 is excellent. The risk of cardiac death or myocardial infarction related to this stenosis is <1\% per year and not decreased by stenting.
This article was published in J Am Coll Cardiol
and referenced in Journal of Health & Medical Informatics