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Five-Year Outcomes ...
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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 ...
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Massachussetts Medical Society,2018
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printrdacarrier
Numbers
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LIBRIS-ID:oai:DiVA.org:oru-68331
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https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-68331URI
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https://doi.org/10.1056/NEJMoa1803538DOI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:138799944URI
Supplementary language notes
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Language:English
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Summary in:English
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Classification
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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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
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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.
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Fournier, S.Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium
(author)
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Pijls, N. H. J.Department of Cardiology, Eindhoven University of Technology, Catharina Hospital, Eindhoven, Netherlands
(author)
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Fearon, W. F.Stanford University Medical Center and Palo Alto Veterans Affairs (VA) Health Care Systems, Stanford CA, United States
(author)
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Barbato, E.Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium
(author)
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Tonino, P. A. L.Department of Cardiology, Eindhoven University of Technology, Catharina Hospital, Eindhoven, Netherlands
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Engström, T.Rigshospitalet University Hospital, D-Copenhagen, Germany
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Kääb, S.Klinikum Der Universitat Munchen-Campus-Innenstadt, Munich, Germany
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Dambrink, J-HIsala Klinieken, Zwolle, Netherlands
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Rioufol, G.Cardiovascular Hospital, Lyon, France
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Toth, G. G.Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium; Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
(author)
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Piroth, Z.Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
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Witt, N.Karolinska Institutet
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Fröbert, Ole,1964-Örebro universitet,Institutionen för medicinska vetenskaper(Swepub:oru)oft
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Kala, P.Masaryk University and University Hospital, Brno, Czech Republic
(author)
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Linke, A.Heart Center Leipzig, Leipzig, Germany; Heart Center Dresden, Dresden, Germany
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Jagic, N.Clinical Center Kragujevac, Kragujevac, Serbia
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Mates, M.Na Homolce Hospital, Prague, Czech Republic
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Mavromatis, K.Atlanta VA Medical Center, Decatur, United States
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Samady, H.Emory University School of Medicine, Atlanta GA, USA
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Irimpen, A.Vascular Institute, Tulane University Heart, New Orleans, United States
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Oldroyd, K.Golden Jubilee National Hospital, Glasgow, United Kingdom
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Campo, G.Gruppo Villa Maria Care and Research, Cardiology Unit, Maria Cecilia Hospital, Ravenna, Italy; Azienda Ospedalieria Universitaria di Ferrara, Ferrara, Italy
(author)
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Rothenbuhler, M.Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
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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)
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De Bruyne, B.Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium
(author)
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Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, BelgiumDepartment of Cardiology, Eindhoven University of Technology, Catharina Hospital, Eindhoven, Netherlands
(creator_code:org_t)
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In:New England Journal of Medicine: Massachussetts Medical Society379:3, s. 250-2590028-47931533-4406
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Xaplanteris, P.
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Fournier, S.
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Pijls, N. H. J.
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Fearon, W. F.
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Barbato, E.
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Tonino, P. A. L.
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Engström, T.
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Kääb, S.
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Dambrink, J-H
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Rioufol, G.
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Toth, G. G.
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Piroth, Z.
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Witt, N.
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Fröbert, Ole, 19 ...
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Kala, P.
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Linke, A.
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Jagic, N.
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Mates, M.
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Mavromatis, K.
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Samady, H.
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Irimpen, A.
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Oldroyd, K.
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Campo, G.
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Rothenbuhler, M.
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Jüni, P.
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De Bruyne, B.
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