Five-Year Outcomes with PCI Guided by Fractional Flow Reserve

J 2018

Five-Year Outcomes with PCI Guided by Fractional Flow Reserve

XAPLANTERIS, P., S. FOURNIER, N.H.J. PIJLS, W.F. FEARON, E. BARBATO et. al.

Basic information

Original name

Five-Year Outcomes with PCI Guided by Fractional Flow Reserve

Authors

XAPLANTERIS, P. (56 Belgium), S. FOURNIER (56 Belgium), N.H.J. PIJLS (528 Netherlands), W.F. FEARON (840 United States of America), E. BARBATO (56 Belgium), P.A.L. TONINO (528 Netherlands), T. ENGSTROM (208 Denmark), S. KAAB (276 Germany), J.H. DAMBRINK (528 Netherlands), G. RIOUFOL (250 France), G.G. TOTH (56 Belgium), Z. PIROTH (348 Hungary), N. WITT (752 Sweden), O. FROBERT (752 Sweden), Petr KALA (203 Czech Republic, belonging to the institution), A. LINKE (276 Germany), N. JAGIC (688 Serbia), M. MATES (203 Czech Republic), K. MAVROMATIS (840 United States of America), H. SAMADY (840 United States of America), A. IRIMPEN (840 United States of America), K. OLDROYD (826 United Kingdom of Great Britain and Northern Ireland), G. CAMPO (380 Italy), M. ROTHENBUHLER (756 Switzerland), P. JUNI (124 Canada) and B. DE BRUYNE (56 Belgium, guarantor)

Edition

New England Journal of Medicine, Waltham, Massachussetts Medical Society, 2018, 0028-4793

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 70.670

RIV identification code

RIV/00216224:14110/18:00104904

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1056/NEJMoa1803538

UT WoS

000439063900008

Keywords in English

fractional flow reserve

Abstract

V originále

BACKGROUND We hypothesized that fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) would be superior to medical therapy as initial treatment in patients with stable coronary artery disease. METHODS Among 1220 patients with angiographically significant stenoses, those in whom at least one stenosis was hemodynamically significant (FFR, <= 0.80) were randomly assigned to FFR-guided PCI plus medical therapy or to medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy and were entered into a registry. The primary end point was a composite of death, myocardial infarction, or urgent revascularization. RESULTS A total of 888 patients underwent randomization (447 patients in the PCI group and 441 in the medical-therapy group). At 5 years, the rate of the primary end point was lower in the PCI group than in the medical-therapy group (13.9% vs. 27.0%; hazard ratio, 0.46; 95% confidence interval (CIS, 0.34 to 0.63; P<0.001). The difference was driven by urgent revascularizations, which occurred in 6.3% of the patients in the PCI group as compared with 21.1% of those in the medical-therapy group (hazard ratio, 0.27; 95% CI, 0.18 to 0.41). There were no significant differences between the PCI group and the medical-therapy group in the rates of death (5.1% and 5.2%, respectively; hazard ratio, 0.98; 95% CI, 0.55 to 1.75) or myocardial infarction (8.1% and 12.0%; hazard ratio, 0.66; 95% CI, 0.43 to 1.00). There was no significant difference in the rate of the primary end point between the PCI group and the registry cohort (13.9% and 15.7%, respectively; hazard ratio, 0.88; 95% CI, 0.55 to 1.39). Relief from angina was more pronounced after PCI than after medical therapy. CONCLUSIONS In patients with stable coronary artery disease, an initial FFR-guided PCI strategy was associated with a significantly lower rate of the primary composite end point of death, myocardial infarction, or urgent revascularization at 5 years than medical therapy alone. Patients without hemodynamically significant stenoses had a favorable long-term outcome with medical therapy alone.

Citovat

XAPLANTERIS, P., S. FOURNIER, N.H.J. PIJLS, W.F. FEARON, E. BARBATO, P.A.L. TONINO, T. ENGSTROM, S. KAAB, J.H. DAMBRINK, G. RIOUFOL, G.G. TOTH, Z. PIROTH, N. WITT, O. FROBERT, Petr KALA, A. LINKE, N. JAGIC, M. MATES, K. MAVROMATIS, H. SAMADY, A. IRIMPEN, K. OLDROYD, G. CAMPO, M. ROTHENBUHLER, P. JUNI and B. DE BRUYNE. Five-Year Outcomes with PCI Guided by Fractional Flow Reserve. New England Journal of Medicine. Waltham: Massachussetts Medical Society, 2018, vol. 379, No 3, p. 250-259. ISSN 0028-4793. Available from: https://dx.doi.org/10.1056/NEJMoa1803538.

@article{1477985,
   author = {Xaplanteris, P. and Fournier, S. and Pijls, N.H.J. and Fearon, W.F. and Barbato, E. and Tonino, P.A.L. and Engstrom, T. and Kaab, S. and Dambrink, J.H. and Rioufol, G. and Toth, G.G. and Piroth, Z. and Witt, N. and Frobert, O. and Kala, Petr and Linke, A. and Jagic, N. and Mates, M. and Mavromatis, K. and Samady, H. and Irimpen, A. and Oldroyd, K. and Campo, G. and Rothenbuhler, M. and Juni, P. and De Bruyne, B.},
   article_location = {Waltham},
   article_number = {3},
   doi = {http://dx.doi.org/10.1056/NEJMoa1803538},
   keywords = {fractional flow reserve},
   language = {eng},
   issn = {0028-4793},
   journal = {New England Journal of Medicine},
   title = {Five-Year Outcomes with PCI Guided by Fractional Flow Reserve},
   volume = {379},
   year = {2018}
}

TY  - JOUR
ID  - 1477985
AU  - Xaplanteris, P. - Fournier, S. - Pijls, N.H.J. - Fearon, W.F. - Barbato, E. - Tonino, P.A.L. - Engstrom, T. - Kaab, S. - Dambrink, J.H. - Rioufol, G. - Toth, G.G. - Piroth, Z. - Witt, N. - Frobert, O. - Kala, Petr - Linke, A. - Jagic, N. - Mates, M. - Mavromatis, K. - Samady, H. - Irimpen, A. - Oldroyd, K. - Campo, G. - Rothenbuhler, M. - Juni, P. - De Bruyne, B.
PY  - 2018
TI  - Five-Year Outcomes with PCI Guided by Fractional Flow Reserve
JF  - New England Journal of Medicine
VL  - 379
IS  - 3
SP  - 250-259
EP  - 250-259
PB  - Massachussetts Medical Society
SN  - 00284793
KW  - fractional flow reserve
N2  - BACKGROUND We hypothesized that fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) would be superior to medical therapy as initial treatment in patients with stable coronary artery disease. METHODS Among 1220 patients with angiographically significant stenoses, those in whom at least one stenosis was hemodynamically significant (FFR, <= 0.80) were randomly assigned to FFR-guided PCI plus medical therapy or to medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy and were entered into a registry. The primary end point was a composite of death, myocardial infarction, or urgent revascularization. RESULTS A total of 888 patients underwent randomization (447 patients in the PCI group and 441 in the medical-therapy group). At 5 years, the rate of the primary end point was lower in the PCI group than in the medical-therapy group (13.9% vs. 27.0%; hazard ratio, 0.46; 95% confidence interval (CIS, 0.34 to 0.63; P<0.001). The difference was driven by urgent revascularizations, which occurred in 6.3% of the patients in the PCI group as compared with 21.1% of those in the medical-therapy group (hazard ratio, 0.27; 95% CI, 0.18 to 0.41). There were no significant differences between the PCI group and the medical-therapy group in the rates of death (5.1% and 5.2%, respectively; hazard ratio, 0.98; 95% CI, 0.55 to 1.75) or myocardial infarction (8.1% and 12.0%; hazard ratio, 0.66; 95% CI, 0.43 to 1.00). There was no significant difference in the rate of the primary end point between the PCI group and the registry cohort (13.9% and 15.7%, respectively; hazard ratio, 0.88; 95% CI, 0.55 to 1.39). Relief from angina was more pronounced after PCI than after medical therapy. CONCLUSIONS In patients with stable coronary artery disease, an initial FFR-guided PCI strategy was associated with a significantly lower rate of the primary composite end point of death, myocardial infarction, or urgent revascularization at 5 years than medical therapy alone. Patients without hemodynamically significant stenoses had a favorable long-term outcome with medical therapy alone.
ER  -

XAPLANTERIS, P., S. FOURNIER, N.H.J. PIJLS, W.F. FEARON, E. BARBATO, P.A.L. TONINO, T. ENGSTROM, S. KAAB, J.H. DAMBRINK, G. RIOUFOL, G.G. TOTH, Z. PIROTH, N. WITT, O. FROBERT, Petr KALA, A. LINKE, N. JAGIC, M. MATES, K. MAVROMATIS, H. SAMADY, A. IRIMPEN, K. OLDROYD, G. CAMPO, M. ROTHENBUHLER, P. JUNI and B. DE BRUYNE. Five-Year Outcomes with PCI Guided by Fractional Flow Reserve. \textit{New England Journal of Medicine}. Waltham: Massachussetts Medical Society, 2018, vol.~379, No~3, p.~250-259. ISSN~0028-4793. Available from: https://dx.doi.org/10.1056/NEJMoa1803538.

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