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  • Xaplanteris, P.Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium (author)

Five-Year Outcomes with PCI Guided by Fractional Flow Reserve

  • Article/chapterEnglish2018

Publisher, publication year, extent ...

  • Massachussetts Medical Society,2018
  • printrdacarrier

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  • LIBRIS-ID:oai:DiVA.org:oru-68331
  • https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-68331URI
  • https://doi.org/10.1056/NEJMoa1803538DOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:138799944URI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Funding Agencies:St. Jude Medical  European Association of Percutaneous Cardiovascular Interventions  Hellenic Cardiological Society  Swiss National Science Foundation  Tier 1 Canada Research Chair in Clinical Epidemiology of Chronic Diseases  Canada Research Chairs Programme 
  • BACKGROUND: We hypothesized that fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) would be superior to medical therapy as initial treatment in patients with stable coronary artery disease.METHODS: Among 1220 patients with angiographically significant stenoses, those in whom at least one stenosis was hemodynamically significant (FFR, <= 0.80) were randomly assigned to FFR-guided PCI plus medical therapy or to medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy and were entered into a registry. The primary end point was a composite of death, myocardial infarction, or urgent revascularization.RESULTS: A total of 888 patients underwent randomization (447 patients in the PCI group and 441 in the medical-therapy group). At 5 years, the rate of the primary end point was lower in the PCI group than in the medical-therapy group (13.9% vs. 27.0%; hazard ratio, 0.46; 95% confidence interval (CIS, 0.34 to 0.63; P<0.001). The difference was driven by urgent revascularizations, which occurred in 6.3% of the patients in the PCI group as compared with 21.1% of those in the medical-therapy group (hazard ratio, 0.27; 95% CI, 0.18 to 0.41). There were no significant differences between the PCI group and the medical-therapy group in the rates of death (5.1% and 5.2%, respectively; hazard ratio, 0.98; 95% CI, 0.55 to 1.75) or myocardial infarction (8.1% and 12.0%; hazard ratio, 0.66; 95% CI, 0.43 to 1.00). There was no significant difference in the rate of the primary end point between the PCI group and the registry cohort (13.9% and 15.7%, respectively; hazard ratio, 0.88; 95% CI, 0.55 to 1.39). Relief from angina was more pronounced after PCI than after medical therapy.CONCLUSIONS: In patients with stable coronary artery disease, an initial FFR-guided PCI strategy was associated with a significantly lower rate of the primary composite end point of death, myocardial infarction, or urgent revascularization at 5 years than medical therapy alone. Patients without hemodynamically significant stenoses had a favorable long-term outcome with medical therapy alone.

Subject headings and genre

Added entries (persons, corporate bodies, meetings, titles ...)

  • Fournier, S.Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium (author)
  • Pijls, N. H. J.Department of Cardiology, Eindhoven University of Technology, Catharina Hospital, Eindhoven, Netherlands (author)
  • Fearon, W. F.Stanford University Medical Center and Palo Alto Veterans Affairs (VA) Health Care Systems, Stanford CA, United States (author)
  • Barbato, E.Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium (author)
  • Tonino, P. A. L.Department of Cardiology, Eindhoven University of Technology, Catharina Hospital, Eindhoven, Netherlands (author)
  • Engström, T.Rigshospitalet University Hospital, D-Copenhagen, Germany (author)
  • Kääb, S.Klinikum Der Universitat Munchen-Campus-Innenstadt, Munich, Germany (author)
  • Dambrink, J-HIsala Klinieken, Zwolle, Netherlands (author)
  • Rioufol, G.Cardiovascular Hospital, Lyon, France (author)
  • Toth, G. G.Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium; Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary (author)
  • Piroth, Z.Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary (author)
  • Witt, N.Karolinska Institutet (author)
  • Fröbert, Ole,1964-Örebro universitet,Institutionen för medicinska vetenskaper(Swepub:oru)oft (author)
  • Kala, P.Masaryk University and University Hospital, Brno, Czech Republic (author)
  • Linke, A.Heart Center Leipzig, Leipzig, Germany; Heart Center Dresden, Dresden, Germany (author)
  • Jagic, N.Clinical Center Kragujevac, Kragujevac, Serbia (author)
  • Mates, M.Na Homolce Hospital, Prague, Czech Republic (author)
  • Mavromatis, K.Atlanta VA Medical Center, Decatur, United States (author)
  • Samady, H.Emory University School of Medicine, Atlanta GA, USA (author)
  • Irimpen, A.Vascular Institute, Tulane University Heart, New Orleans, United States (author)
  • Oldroyd, K.Golden Jubilee National Hospital, Glasgow, United Kingdom (author)
  • Campo, G.Gruppo Villa Maria Care and Research, Cardiology Unit, Maria Cecilia Hospital, Ravenna, Italy; Azienda Ospedalieria Universitaria di Ferrara, Ferrara, Italy (author)
  • Rothenbuhler, M.Clinical Trials Unit Bern, University of Bern, Bern, Switzerland (author)
  • Jüni, P.Applied Health Research Centre, Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada (author)
  • De Bruyne, B.Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium (author)
  • Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, BelgiumDepartment of Cardiology, Eindhoven University of Technology, Catharina Hospital, Eindhoven, Netherlands (creator_code:org_t)

Related titles

  • In:New England Journal of Medicine: Massachussetts Medical Society379:3, s. 250-2590028-47931533-4406

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