title: Deferral vs. performance of percutaneous coronary intervention of functionally non-significant coronary stenosis: 15-year follow-up of the DEFER trial.
abstract: OBJECTIVE
  Stenting an angiographically intermediate but functionally non-significant stenosis is controversial. Nevertheless, it has been questioned if deferral of a functionally non-significant lesion on the basis of fractional flow reserve (FFR) measurement, is safe, especially on the long term. Five-year follow-up of the DEFER trial showed that outcome after deferral of percutaneous coronary intervention (PCI) of an intermediate coronary stenosis based on FFR ≥ 0.75 is excellent and was not improved by stenting. The aim of this study was to investigate the validity of this position on the very long term.
  
  
  RESULTS
  In 325 patients scheduled for PCI of an intermediate stenosis, FFR was measured just before the planned intervention. If FFR was ≥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 15 years. There were no differences in baseline clinical characteristics between the randomized groups. Complete 15-year follow-up was obtained in 92% of patients. After 15 years of follow-up, the rate of death was not different between the three groups: 33.0% in the Defer group, 31.1% in the Perform group, and 36.1% in the Reference group (Defer vs. Perform, RR 1.06, 95% CI: 0.69-1.62, P = 0.79). The rate of myocardial infarction was significantly lower in the Defer group (2.2%) compared with the Perform group (10.0%), RR 0.22, 95% CI: 0.05-0.99, P = 0.03.
  
  
  CONCLUSIONS
  Deferral of PCI of a functionally non-significant stenosis is associated with a favourable very long-term follow-up without signs of late 'catch-up' phenomenon.
authors.affiliation: Department of Cardiology, Catharina Hospital Eindhoven, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands.
authors.forename: Frederik M
authors.initials: FM
authors.lastname: Zimmermann
authors.affiliation: Cardiovascular Center, Aalst, Belgium.
authors.forename: Angela
authors.initials: A
authors.lastname: Ferrara
authors.affiliation: Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, TX, USA.
authors.forename: Nils P
authors.initials: NP
authors.lastname: Johnson
authors.affiliation: Department of Cardiology, Catharina Hospital Eindhoven, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors.forename: Lokien X
authors.initials: LX
authors.lastname: van Nunen
authors.affiliation: Hospital Clínico San Carlos/Faculty of Medicine, Complutense University of Madrid, and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital Gothenburg, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Albertsson
authors.affiliation: Department of Cardiology, West-German Heart and Vascular Centre, University Hospital of Essen, Essen, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.affiliation: Department of Cardiology, University Hospital of Liège, Liège, Belgium.
authors.forename: Victor
authors.initials: V
authors.lastname: Legrand
authors.affiliation: Division of Cardiology, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hyeong-Cheol
authors.initials: HC
authors.lastname: Gwon
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Wouter S
authors.initials: WS
authors.lastname: Remkes
authors.affiliation: Department of Interventional Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Pieter R
authors.initials: PR
authors.lastname: Stella
authors.affiliation: Department of Cardiology, VieCuri, Venlo, The Netherlands.
authors.forename: Pepijn
authors.initials: P
authors.lastname: van Schaardenburgh
authors.affiliation: Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands Reinier de Graaf Groep, Delft, The Netherlands.
authors.forename: G Jan Willem
authors.initials: GJ
authors.lastname: Bech
authors.affiliation: Cardiovascular Center, Aalst, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.affiliation: Department of Cardiology, Catharina Hospital Eindhoven, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands nico.pijls@inter.nl.net carias@cze.nl.
authors.forename: Nico H J
authors.initials: NH
authors.lastname: Pijls
mesh_terms: D023921:Coronary Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality; D062645:Percutaneous Coronary Intervention; D012008:Recurrence; D012086:Reoperation; D015607:Stents; D016896:Treatment Outcome; D057832:Watchful Waiting
keywords: Coronary artery disease; Fractional flow reserve; Long-term follow-up; Percutaneous coronary intervention