Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study.
OBJECTIVE
The purpose of this study was to investigate the appropriateness of stenting a functionally nonsignificant stenosis.


BACKGROUND
Percutaneous coronary intervention (PCI) of an intermediate stenosis without evidence of ischemia is often performed, but its benefit is unproven. Coronary pressure-derived fractional flow reserve (FFR) is an invasive index used to identify a stenosis responsible for reversible ischemia.


METHODS
In 325 patients scheduled for PCI of an intermediate stenosis, FFR was measured just before the planned intervention. If FFR was >or =0.75, patients were randomly assigned to deferral (Defer group; n = 91) or performance (Perform group; n = 90) of PCI. If FFR was <0.75, PCI was performed as planned (Reference group; n = 144). Clinical follow-up was 5 years.


RESULTS
There were no differences in baseline clinical characteristics between the 3 groups. Complete follow-up was obtained in 98% of the patients. Event-free survival was not different between the Defer and Perform groups (80% and 73%, respectively; p = 0.52), but was significantly worse in the Reference group (63%; p = 0.03). The composite rate of cardiac death and acute myocardial infarction in the Defer, Perform, and Reference groups was 3.3%, 7.9%, and 15.7%, respectively (p = 0.21 for Defer vs. Perform group; p = 0.003 for the Reference vs. both other groups). The percentage of patients free from chest pain at follow-up was not different between the Defer and Perform groups.


CONCLUSIONS
Five-year outcome after deferral of PCI of an intermediate coronary stenosis based on FFR >/=0.75 is excellent. The risk of cardiac death or myocardial infarction related to this stenosis is <1% per year and not decreased by stenting.
Pijls
Nico H J
NH
Catharina Hospital Eindhoven, Eindhoven, The Netherlands. nico.pijls@inter.nl.net
van Schaardenburgh
Pepijn
P
Manoharan
Ganesh
G
Boersma
Eric
E
Bech
Jan-Willem
JW
van't Veer
Marcel
M
Bär
Frits
F
Hoorntje
Jan
J
Koolen
Jacques
J
Wijns
William
W
de Bruyne
Bernard
B
D000789:Angina, Unstable / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001783:Blood Flow Velocity; D002637:Chest Pain / Q000453:epidemiology / Q000628:therapy; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012720:Severity of Illness Index; D015607:Stents
D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors