title: Five-year follow-up in patients after therapy stratification based on intracoronary pressure measurement.
abstract: BACKGROUND
  Invasive coronary angiography (ICA) alone fails to accurately select patients with intermediate stenoses who should be treated by percutaneous coronary intervention (PCI). Previous studies have demonstrated the usefulness of fractional flow reserve (FFR) for identifying patients in whom deferring an intended PCI would be more beneficial than performing the planned procedure. The long-term safety of FFR-based therapy stratification, however, remains unknown. Therefore, the aim of this study was to retrospectively evaluate the long-term safety of an FFR-based therapy stratification in patients with intermediate coronary lesions detected by ICA.
  
  
  METHODS
  We included 56 patients presenting with a 50% to 75% angiographic stenosis by visual assessment on ICA, with negative, inconclusive, or no stress test, and in whom the intended PCI was deferred based on the result of the FFR measurement (ie, FFR > or = 0.75). The occurrence of major adverse cardiac events during a 5-year follow-up period was recorded.
  
  
  RESULTS
  A complete 5-year follow-up was available in all patients. Mean follow-up was 1868 +/- 380 days. During follow-up, 16 events (1 cardiac death, 4 noncardiac deaths, 11 revascularization procedures) occurred. The combined rate of cardiac death and nonfatal myocardial infarction was 1.8% over 5 years. Nine PCI procedures (5 target vessel, 4 nontarget vessel) were performed during follow-up based on objective signs of ischemia. The angina status was not different between inclusion and the 5-year follow-up.
  
  
  CONCLUSIONS
  Deferring PCI in patients without critical reduction in FFR may be a safe option during long-term follow-up.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard University, Boston, MA 02114, USA. j.r@lmu.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Rieber
authors.forename: Philip
authors.initials: P
authors.lastname: Jung
authors.forename: Andreas
authors.initials: A
authors.lastname: Koenig
authors.forename: Thomas
authors.initials: T
authors.lastname: Schiele
authors.forename: Michael
authors.initials: M
authors.lastname: Shapiro
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Volker
authors.initials: V
authors.lastname: Klauss
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000503:physiopathology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D015897:Comorbidity; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome