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  3. Fractional Flow Reserve–Guided PCI for Stable Coronary Artery Disease
 

Fractional Flow Reserve–Guided PCI for Stable Coronary Artery Disease

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BORIS DOI
10.7892/boris.58383
Date of Publication
September 1, 2014
Publication Type
Article
Division/Institute

Departement Klinische...

Institut für Sozial- ...

Author
De Bruyne, Bernard
Fearon, William F
Pijls, Nico H J
Barbato, Emanuele
Tonino, Pim
Piroth, Zsolt
Jagic, Nikola
Mobius-Winckler, Sven
Riouffol, 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, Andreasorcid-logo
Departement Klinische Forschung, Core Facility, Clinical Trials Unit (CTU) Bern
Nüesch, Eveline
Institut für Sozial- und Präventivmedizin (ISPM)
Departement Klinische Forschung, Core Facility, Clinical Trials Unit (CTU) Bern
Jüni, Peter
Institut für Sozial- und Präventivmedizin (ISPM)
Departement Klinische Forschung, Core Facility, Clinical Trials Unit (CTU) Bern
Subject(s)

600 - Technology::610...

300 - Social sciences...

Series
New England journal of medicine NEJM
ISSN or ISBN (if monograph)
0028-4793
Publisher
Massachusetts Medical Society MMS
Language
English
Publisher DOI
10.1056/NEJMoa1408758
PubMed ID
25176289
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 infection 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. (Funded by St. Jude Medical; FAME 2 ClinicalTrials.gov number, NCT01132495 .).
Handle
https://boris-portal.unibe.ch/handle/20.500.12422/126278
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DeBruyne NEnglJMed 2014.pdftextAdobe PDF614.34 KBpublisherpublishedOpen
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