title: Long-term follow-up of patients with deferred coronary intervention guided by measurement of fractional flow reserve.
abstract: OBJECTIVE
  The functional significance of coronary lesions can be assessed in the cardiac catheterization laboratory by determination of fractional flow reserve (FFR), thus overcoming one of the major limitations of conventional angiography. The aim of this study was to analyze the long-term clinical course of patients with intermediate coronary stenosis (50-70%) deferred for intervention based on FFR <0.80.
  
  
  METHODS
  Between May 1999 and December 2009, 300 lesions in 231 patients (mean age 65 ± 10 years, 68% male and 75.3% with multivessel disease) were studied by FFR. Intervention was deferred in 282 (94%) lesions and 18 were treated based on FFR <0.80. We assessed the occurrence of major adverse cardiovascular events (MACE), defined as cardiovascular death, non-fatal acute coronary syndrome and target lesion revascularization (TLR).
  
  
  RESULTS
  During a median follow-up of 637 days (interquartile range 455-1160), there were 15 (6.5%) MACE in the subgroup of patients with target lesion intervention deferred based on FFR: one cardiovascular death, four hospitalizations for acute coronary syndrome and 14 TLR (12 patients were treated percutaneously and two underwent coronary artery bypass grafting). MACE-free survival at one year follow-up was 97.8%.
  
  
  CONCLUSIONS
  These results, in a real-world population, support the current trend to base the decision to treat on functional rather than purely anatomical criteria, in order to improve safety and efficiency.
authors.affiliation: Clínica Universitária de Cardiologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
authors.forename: Luísa
authors.initials: L
authors.lastname: Vilalonga Pereira
authors.forename: Hélder
authors.initials: H
authors.lastname: Pereira
authors.forename: Hugo
authors.initials: H
authors.lastname: Vinhas
authors.forename: Cristina
authors.initials: C
authors.lastname: Martins
authors.forename: Rita
authors.initials: R
authors.lastname: Calé
authors.forename: Ernesto
authors.initials: E
authors.lastname: Pereira
authors.forename: Sílvia
authors.initials: S
authors.lastname: Vitorino
authors.forename: Ricardo
authors.initials: R
authors.lastname: Esteves
authors.forename: Jorge
authors.initials: J
authors.lastname: Marques
authors.forename: Carlos
authors.initials: C
authors.lastname: Ciríaco
authors.forename: Ana
authors.initials: A
authors.lastname: Almeida
mesh_terms: D000368:Aged; D015331:Cohort Studies; D023921:Coronary Stenosis / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization; D012189:Retrospective Studies; D013997:Time Factors
keywords: Angioplastia; Angioplasty; Fractional flow reserve; Fração do fluxo de reserva coronária; Ischemia; Isquémia; Stent