Clinical Studies
Long-Term Follow-Up After Deferral of Percutaneous Transluminal Coronary Angioplasty of Intermediate Stenosis on the Basis of Coronary Pressure Measurement 1

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Abstract

Objectives. This study sought to determine the safety of deferral of percutaneous transluminal coronary angioplasty (PTCA) of angiographically intermediate but functionally nonsignificant stenosis, as assessed by coronary pressure measurement and myocardial fractional flow reserve (FFRmyo).

Background. Decision making in patients with chest pain and intermediate coronary stenosis remains difficult. In these cases it is unclear whether the risk of an intervention and the potentially subsequent restenosis outweigh the future risk of an event if the lesion remains untreated. FFRmyois a lesion-specific functional index of epicardial stenosis severity that accurately distinguishes stenoses associated with inducible ischemia.

Methods. Retrospective analysis and follow-up was performed in 100 consecutive patients referred to our centers for PTCA of an intermediate stenosis but in whom the planned intervention was deferred on the basis of an FFRmyo≥0.75.

Results. During a follow-up period of 18 ± 13 months (mean ± SD, range 3 to 42), two patients died of noncardiac causes. Ninety patients remained free of any coronary events, and their average Canadian Cardiovascular Society class decreased from 2.0 ± 1.2 at baseline to 0.7 ± 0.9 at follow-up (p < 0.0001). A coronary event occurred in eight patients and was target-vessel related in four.

Conclusions. In patients with chest pain referred for PTCA of an intermediate stenosis, deferral of the intervention on the basis of an FFRmyo≥0.75 is safe and is associated with a much lower clinical event rate than if the procedure had been performed as initially planned in these patients.

Abbreviations

CCS
Canadian Cardiology Society
FFRmyo
myocardial fractional flow reserve
Pa
mean aortic pressure
Pd
mean distal coronary pressure, measured at maximal coronary hyperemia
PTCA
percutaneous transluminal coronary angioplasty
QCA
quantitative coronary arteriography

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1

This study was supported in part by Grant 95001 from the “Stichting Vrienden van het Hart” (Friends of the Heart Foundation), Eindhoven, The Netherlands.