Publication details

Fractional Flow Reserve-Guided PCI for Stable Coronary Artery Disease

Authors	DE BRUYNE Bernard FEARON William F. PIJLS Nico H.J. BARBATO Emanuele TONINO Pim PIROTH Zsolt JAGIC Nicola MOBIUS-WINCKLER Sven RIOUFOL Gilles WITT Nils KALA Petr MACCARTHY Philip ENGSTRÖM Thomas OLDROYD Keith MAVROMATIS Kreton MANOHARAN Ganesh VERLEE Peter FROBERT Ole CURZEN Nick JOHNSON jane B. LIMACHER Andreas NÜESCH Eveline JÜNI Peter
Year of publication	2014
Type	Article in Periodical
Magazine / Source	New England Journal of Medicine
MU Faculty or unit	Faculty of Medicine
Citation
Doi	http://dx.doi.org/10.1056/NEJMoa1408758
Field	Cardiovascular diseases incl. cardiosurgery
Keywords	angiotensin receptor antagonist; beta adrenergic receptor blocking agent; dipeptidyl carboxypeptidase inhibitor
Description	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.