title: Long-Term Clinical Outcomes of Fractional Flow Reserve-Guided Versus Routine Drug-Eluting Stent Implantation in Patients With Intermediate Coronary Stenosis: Five-Year Clinical Outcomes of DEFER-DES Trial.
abstract: BACKGROUND
  We aimed to compare the long-term clinical outcomes between fractional flow reserve (FFR)-guided and routine drug-eluting stent (DES) implantation in patients with an intermediate coronary stenosis.
  
  
  RESULTS
  A total of 229 patients with an angiographically intermediate coronary stenosis were randomly assigned to FFR-guided or Routine-DES implantation group. For FFR-guided group (n=114), treatment strategy was determined according to the target vessel FFR (FFR<0.75: DES implantation [FFR-DES group]; FFR≥0.75: deferral of stenting [FFR-Defer group]). Routine-DES group underwent DES implantation without FFR measurement (n=115). The primary end point was the incidence of major adverse cardiac events, a composite of cardiac death, myocardial infarction, and target lesion revascularization. Of lesions assigned to FFR-guided strategy, only one quarter had functional significance (FFR<0.75). At 2-year follow-up, the cumulative incidence of major adverse cardiac events was 7.9±2.5% in the FFR-guided group and 8.8±2.7% in Routine-DES group (P=0.80). At 5-year follow-up, the cumulative incidence of major adverse cardiac events was 11.6±3.0% and 14.2±3.3% for the FFR-guided group and the Routine-DES group (P=0.55). There was no difference in major adverse cardiac events rates between the 2 groups ≤5-year follow-up (hazard ratio, 1.25; 95% confidence interval, 0.60-2.60).
  
  
  CONCLUSIONS
  In lesions with angiographically intermediate stenosis, FFR guidance provides a tailored approach, which is at least as good as an angiography-guided routine-DES implantation strategy and avoids unnecessary DES-stenting in a considerable part of the patients.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00592228.
authors.affiliation: From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.).
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Park
authors.affiliation: From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.).
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Jeon
authors.affiliation: From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.).
authors.forename: Joo Myung
authors.initials: JM
authors.lastname: Lee
authors.affiliation: From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.).
authors.forename: Chang-Wook
authors.initials: CW
authors.lastname: Nam
authors.affiliation: From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.).
authors.forename: Joon-Hyung
authors.initials: JH
authors.lastname: Doh
authors.affiliation: From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.).
authors.forename: Bong-Ki
authors.initials: BK
authors.lastname: Lee
authors.affiliation: From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.).
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.affiliation: From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.).
authors.forename: Ki-dong
authors.initials: KD
authors.lastname: Yoo
authors.affiliation: From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.).
authors.forename: Kyung Tae
authors.initials: KT
authors.lastname: Jung
authors.affiliation: From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.).
authors.forename: Young-Seok
authors.initials: YS
authors.lastname: Cho
authors.affiliation: From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.).
authors.forename: Hae-Young
authors.initials: HY
authors.lastname: Lee
authors.affiliation: From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.).
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Youn
authors.affiliation: From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.).
authors.forename: Woo-Young
authors.initials: WY
authors.lastname: Chung
authors.affiliation: From the Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea (S.H.P., K.T.J.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); Department of Internal Medicine (J.M.L., H.-Y.L., B.-K.K.) and Institute of Aging (B.-K.K.), Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea (C.-W.N.); Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea (J.-H.D.); Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea (B.-K.L.); Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea (S.-W.R.); Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea (K.-d.Y.); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (Y.-S.C., T.-J.Y.); and Department of Internal Medicine, Seoul National University Boramae Medical Center, Korea, Seoul, Korea (W.-Y.C.). bkkoo@snu.ac.kr.
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: coronary artery disease; coronary stenosis; drug-eluting stents; myocardial fractional flow reserve; percutaneous coronary intervention