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@article{1216719,
author = {DE Bruyne, Bernard and Fearon, William F. and Pijls, Nico H.J. and Barbato, Emanuele and Tonino, Pim and Piroth, Zsolt and Jagic, Nicola and MobiusandWinckler, Sven and Rioufol, Gilles and Witt, Nils and Kala, Petr and MacCarthy, Philip and Engström, Thomas and Oldroyd, Keith and Mavromatis, Kreton and Manoharan, Ganesh and Verlee, Peter and Frobert, Ole and Curzen, Nick and Johnson, jane B. and Limacher, Andreas and Nüesch, Eveline and Jüni, Peter},
article_location = {Waltham},
article_number = {13},
doi = {http://dx.doi.org/10.1056/NEJMoa1408758},
keywords = {angiotensin receptor antagonist; beta adrenergic receptor blocking agent; dipeptidyl carboxypeptidase inhibitor},
language = {eng},
issn = {0028-4793},
journal = {New England Journal of Medicine},
title = {Fractional Flow Reserve-Guided PCI for Stable Coronary Artery Disease},
volume = {371},
year = {2014}
}
TY - JOUR
ID - 1216719
AU - 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
PY - 2014
TI - Fractional Flow Reserve-Guided PCI for Stable Coronary Artery Disease
JF - New England Journal of Medicine
VL - 371
IS - 13
SP - 1208-1217
EP - 1208-1217
PB - Massachussetts Medical Society
SN - 00284793
KW - angiotensin receptor antagonist
KW - beta adrenergic receptor blocking agent
KW - dipeptidyl carboxypeptidase inhibitor
N2 - 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.
ER -
DE BRUYNE, Bernard, William F. FEARON, Nico H.J. PIJLS, Emanuele BARBATO, Pim TONINO, Zsolt PIROTH, Nicola JAGIC, Sven MOBIUS-WINCKLER, Gilles RIOUFOL, Nils WITT, Petr KALA, Philip MACCARTHY, Thomas ENGSTRÖM, Keith OLDROYD, Kreton MAVROMATIS, Ganesh MANOHARAN, Peter VERLEE, Ole FROBERT, Nick CURZEN, jane B. JOHNSON, Andreas LIMACHER, Eveline NÜESCH a Peter JÜNI. Fractional Flow Reserve-Guided PCI for Stable Coronary Artery Disease. \textit{New England Journal of Medicine}. Waltham: Massachussetts Medical Society, roč.~371, č.~13, s.~1208-1217. ISSN~0028-4793. doi:10.1056/NEJMoa1408758. 2014.
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