The effect of drug eluting stents on cardiovascular events in patients with intermediate lesions and borderline fractional flow reserve.
OBJECTIVE
To assess the role of fractional flow reserve (FFR) in guiding therapy in the drug eluting stent (DES) era.


BACKGROUND
FFR is a useful index for evaluation of the physiological significance of angiographically indeterminate coronary artery lesions. However, its role in the DES era is unknown.


METHODS
Long term outcome of 281 patients with angiographically indeterminate coronary lesions and borderline FFR (0.75 </= FFR < 0.9) was obtained. The outcome of patients who had a DES placed (n = 58), was compared with that of consecutive patients with borderline FFR that were treated by PCI with bare metal stents (BMS, n = 58), or were deferred from revascularization (n = 165).


RESULTS
FFR was significantly higher in the deferred group (median and IQR); 0.85 (0.82 to 0.88) compared with the BMS (0.78; 0.76 to 0.82) and the DES (0.79; 0.77 to 0.82), P < 0.001. Pretreatment FFR was a significant determinant of long term event rates in the deferred patients (P = 0.002) but had no effect in patients treated by PCI. In the deferred group, there were fewer events (death, myocardial infarction, target vessel revascularization) compared with the BMS group; but no significant difference was observed between the DES and the deferred groups.


CONCLUSIONS
In borderline FFR, long term outcome after PCI with BMS is inferior to conservative therapy or PCI with DES. While conservative management is preferable in these patients, PCI with DES may be considered in specific circumstances.
Lavi
Shahar
S
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Rihal
Charanjit S
CS
Yang
Eric H
EH
Fassa
Amir-Ali
AA
Elesber
Ahmad
A
Lennon
Ryan J
RJ
Mathew
Verghese
V
David
Holmes R
HR
Lerman
Amir
A
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D002318:Cardiovascular Diseases / Q000209:etiology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D008670:Metals