title: Significance of Intermediate Values of Fractional Flow Reserve in Patients With Coronary Artery Disease.
abstract: BACKGROUND
  The fractional flow reserve (FFR) value of 0.75 has been validated against ischemic testing, whereas the FFR value of 0.80 has been widely accepted to guide clinical decision making. However, revascularization when FFR is 0.76 to 0.80, within the so-called gray zone, is still debatable.
  
  
  RESULTS
  From February 1997 to June 2013, all patients with single-segment disease and an FFR value within the gray zone or within the 2 neighboring FFR strata (0.70-0.75 and 0.81-0.85) were included. Study end points consisted of major adverse cardiovascular events (death, myocardial infarction, and any revascularization) up to 5 years. Of 17 380 FFR measurements, 1459 patients were included. Of them, 449 patients were treated with revascularization and 1010 patients were treated with medical therapy. In the gray zone, the major adverse cardiovascular events rate was similar (37 [13.9%] versus 21 [11.2%], respectively; P=0.3) between medical therapy and revascularization, whereas a strong trend toward a higher rate of death or myocardial infarction (25 [9.4] versus 9 [4.8], P=0.06) and overall death (20 [7.5] versus 6 [3.2], P=0.059) was observed in the medical therapy group. Among medical therapy patients, a significant step-up increase in major adverse cardiovascular events rate was observed across the 3 FFR strata, especially with proximal lesion location. In revascularization patients, the major adverse cardiovascular events rate was not different across the 3 FFR strata.
  
  
  CONCLUSIONS
  FFR in and around the gray zone bears a major prognostic value, especially in proximal lesions. These data confirm that FFR≤0.80 is valid to guide clinical decision making.
authors.affiliation: From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
authors.forename: Julien
authors.initials: J
authors.lastname: Adjedj
authors.affiliation: From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.affiliation: From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
authors.forename: Vincent
authors.initials: V
authors.lastname: Floré
authors.affiliation: From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Gioia
authors.affiliation: From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
authors.forename: Angela
authors.initials: A
authors.lastname: Ferrara
authors.affiliation: From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
authors.forename: Mariano
authors.initials: M
authors.lastname: Pellicano
authors.affiliation: From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
authors.forename: Gabor G
authors.initials: GG
authors.lastname: Toth
authors.affiliation: From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
authors.forename: Jozef
authors.initials: J
authors.lastname: Bartunek
authors.affiliation: From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
authors.forename: Marc
authors.initials: M
authors.lastname: Vanderheyden
authors.affiliation: From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
authors.forename: Guy R
authors.initials: GR
authors.lastname: Heyndrickx
authors.affiliation: From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.).
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.affiliation: From Cardiovascular Research Center Aalst OLV Clinic, Aalst, Belgium (J.A., B.D.B., V.F., G.D.G., A.F., M.P., G.G.T., J.B., M.V., G.R.H., W.W., E.B.); Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.D.G., M.P., E.B.); and University Heart Centre Graz, Medical University Graz, Austria (G.G.T.). emanuele.barbato@olvz-aalst.be.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Barbato
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D012189:Retrospective Studies
keywords: coronary artery disease; fractional flow reserve; mortality; myocardial revascularization; patient outcome assessment