Home > Interventional Cardiology, Journal Club > Journal Club 8 October 2014

Journal Club 8 October 2014

Paper

Fractional Flow Reserve–Guided PCI for Stable Coronary Artery Disease

Presenter

CC

Summary

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.

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