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Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study.

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.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Pijls NH,van Schaardenburgh P,Manoharan G,Boersma E,Bech JW,van't Veer M,Bär F,Hoorntje J,Koolen J,Wijns W,de Bruyne B

doi

10.1016/j.jacc.2007.01.087

subject

Has Abstract

pub_date

2007-05-29 00:00:00

pages

2105-11

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(07)00911-4

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study.