Fractional Flow Reserve–Guided PCI versus Medical Therapy in Stable Coronary Disease

• Published in: The New England journal of medicine Vol. 367; no. 11; pp. 991 - 1001
• Main Authors: De Bruyne, Bernard, Pijls, Nico H.J, Kalesan, Bindu, Barbato, Emanuele, Tonino, Pim A.L, Piroth, Zsolt, Jagic, Nikola, Mobius-Winckler, Sven, Rioufol, Gilles, Witt, Nils, Kala, Petr, MacCarthy, Philip, Engström, Thomas, Oldroyd, Keith G, Mavromatis, Kreton, Manoharan, Ganesh, Verlee, Peter, Frobert, Ole, Curzen, Nick, Johnson, Jane B, Jüni, Peter, Fearon, William F
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 13.09.2012
• Subjects: Acute coronary syndromes; Adrenergic beta-1 Receptor Antagonists; Aged; Angioplasty, Balloon, Coronary - methods; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Aspirin - therapeutic use; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Combined Modality Therapy; Coronary artery; Coronary Disease - drug therapy; Coronary Disease - mortality; Coronary Disease - therapy; Coronary heart disease; Coronary Stenosis - therapy; Coronary vessels; Drug Therapy, Combination; Drug-Eluting Stents; EKG; Female; Follow-Up Studies; Fractional Flow Reserve, Myocardial; General aspects; Heart; Heart attacks; Heart diseases; Humans; Ischemia; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Myocardial infarction; Myocardial Infarction - epidemiology; Myocardial Infarction - prevention & control; Patients; Platelet Aggregation Inhibitors - therapeutic use; Retreatment; Stenosis; Guidance; Medicine; Cardiovascular disease; Treatment; Coronary heart disease; Comparative study
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1205361

In this trial, fractional flow reserve was used to assess the functional significance of coronary stenoses in patients with clinically stable coronary artery disease. The clinical outcomes were better when this technique was used to direct the use of coronary stenting. Percutaneous coronary intervention (PCI) improves the outcome in patients with acute coronary syndromes. 1 In contrast, for the treatment of patients with stable coronary artery disease, controversy persists regarding the extent of the benefit from PCI, as compared with the best available medical therapy, as an initial management strategy. 2 – 5 The potential benefit of revascularization depends on the presence and extent of myocardial ischemia. 6 – 8 Performing PCI on nonischemic stenoses is not beneficial 9 and is probably harmful. 10 Thus, careful selection of ischemia-inducing stenoses is essential for deriving the greatest benefit from revascularization in patients with stable coronary artery disease. Fractional flow . . .