title: Long-term outcome after deferral of revascularization in patients with intermediate coronary stenosis and gray-zone fractional flow reserve.
abstract: BACKGROUND
  A strategy of deferred percutaneous coronary intervention for coronary stenosis with fractional flow reserve (FFR) 0.75-0.80, termed the gray zone, remains a matter of debate. The aim of this study was to assess the safety of deferring revascularization for patients with FFR 0.75-0.80 compared with those with FFR >0.80.
  
  
  RESULTS
  We assessed 3-year clinical outcome in 150 patients with angiographically intermediate stenosis who had revascularization deferred on the basis of FFR ≥ 0.75 (FFR 0.75-0.80, n=56; FFR >0.80, n=94). Target vessel failure (TVF), defined as a composite of cardiac death, target vessel-related myocardial infarction (MI), and ischemia-driven target vessel revascularization (TVR) was evaluated during follow-up. Cardiac death was observed in 1 patient with FFR 0.75-0.80. There was no target vessel-related MI in either group. The incidence of ischemia-driven TVR was higher in patients with FFR 0.75-0.80 than in those with FFR >0.80 (14% vs. 3%, P=0.020). TVF-free survival was significantly worse for the patients with FFR 0.75-0.80 than those with FFR >0.80 (hazard ratio, 5.2; 95% confidence intervals: 1.4-19.5; P=0.015).
  
  
  CONCLUSIONS
  Patients with FFR 0.75-0.80 were at higher risk of TVF mainly due to TVR than those with FFR >0.80.
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University.
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Shiono
authors.forename: Takashi
authors.initials: T
authors.lastname: Kubo
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ino
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanimoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamano
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Matsuo
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nishiguchi
authors.forename: Ikuko
authors.initials: I
authors.lastname: Teraguchi
authors.forename: Shingo
authors.initials: S
authors.lastname: Ota
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ozaki
authors.forename: Makoto
authors.initials: M
authors.lastname: Orii
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shimamura
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitabata
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hirata
authors.forename: Toshio
authors.initials: T
authors.lastname: Imanishi
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
mesh_terms: D000255:Adenosine Triphosphate / Q000494:pharmacology; D000368:Aged; D001794:Blood Pressure; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003331:Coronary Vessels; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000255:Adenosine Triphosphate