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Fractional Flow Reserve-Guided PCI for Stable Coronary Artery Disease
Cardiovasc Ctr Aalst, Onze Lieve Vrouw Hosp, Aalst, Belgium.
Med Ctr, Stanford Univ, Stanford CA, USA.; Palo Alto Vet Affairs Hlth Care Syst, Stanford CA USA.
Dept Cardiol, Catharina Hosp, Eindhoven, Netherlands; Dept Biomed Engn, Eindhoven Univ Technol, Eindhoven, Netherlands.
Cardiovasc Ctr Aalst, Onze Lieve Vrouw Hosp, Aalst, Belgium.ORCID iD: 0000-0002-0050-5178
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2014 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 371, no 13, p. 1208-1217Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: We hypothesized that in patients with stable coronary artery disease and stenosis, percutaneous coronary intervention (PCI) performed on the basis of the fractional flow reserve (FFR) would be superior to medical therapy.

METHODS: In 1220 patients with stable coronary artery disease, we assessed the FFR in all stenoses that were visible on angiography. Patients who had at least one stenosis with an FFR of 0.80 or less were randomly assigned to undergo FFR-guided PCI plus medical therapy or to receive medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy alone and were included in a registry. The primary end point was a composite of death from any cause, nonfatal myocardial infarction, or urgent revascularization within 2 years.

RESULTS: The rate of the primary end point was significantly lower in the PCI group than in the medical-therapy group (8.1% vs. 19.5%; hazard ratio, 0.39; 95% confidence interval [CI], 0.26 to 0.57; P<0.001). This reduction was driven by a lower rate of urgent revascularization in the PCI group (4.0% vs. 16.3%; hazard ratio, 0.23; 95% CI, 0.14 to 0.38; P<0.001), with no significant between-group differences in the rates of death and myocardial infarction. Urgent revascularizations that were triggered by myocardial infarction or ischemic changes on electrocardiography were less frequent in the PCI group (3.4% vs. 7.0%, P = 0.01). In a landmark analysis, the rate of death or myocardial infarction from 8 days to 2 years was lower in the PCI group than in the medical-therapy group (4.6% vs. 8.0%, P = 0.04). Among registry patients, the rate of the primary end point was 9.0% at 2 years.

CONCLUSIONS: In patients with stable coronary artery disease, FFR-guided PCI, as compared with medical therapy alone, improved the outcome. Patients without ischemia had a favorable outcome with medical therapy alone.

Place, publisher, year, edition, pages
Massachussetts Medical Society , 2014. Vol. 371, no 13, p. 1208-1217
National Category
General Practice
Identifiers
URN: urn:nbn:se:oru:diva-56369DOI: 10.1056/NEJMoa1408758ISI: 000342079700008PubMedID: 25176289Scopus ID: 2-s2.0-84907423839OAI: oai:DiVA.org:oru-56369DiVA, id: diva2:1081902
Note

Funding Agency:

St. Jude Medical

Available from: 2017-03-15 Created: 2017-03-15 Last updated: 2018-06-19Bibliographically approved

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