Clinical Research
Interventional Cardiology
Percutaneous Coronary Intervention of Functionally Nonsignificant Stenosis: 5-Year Follow-Up of the DEFER Study

https://doi.org/10.1016/j.jacc.2007.01.087Get rights and content
Under an Elsevier user license
open archive

Objectives

The purpose of this study was to investigate the appropriateness of stenting a functionally nonsignificant stenosis.

Background

Percutaneous coronary intervention (PCI) of an intermediate stenosis without evidence of ischemia is often performed, but its benefit is unproven. Coronary pressure-derived fractional flow reserve (FFR) is an invasive index used to identify a stenosis responsible for reversible ischemia.

Methods

In 325 patients scheduled for PCI of an intermediate stenosis, FFR was measured just before the planned intervention. If FFR was ≥0.75, patients were randomly assigned to deferral (Defer group; n = 91) or performance (Perform group; n = 90) of PCI. If FFR was <0.75, PCI was performed as planned (Reference group; n = 144). Clinical follow-up was 5 years.

Results

There were no differences in baseline clinical characteristics between the 3 groups. Complete follow-up was obtained in 98% of the patients. Event-free survival was not different between the Defer and Perform groups (80% and 73%, respectively; p = 0.52), but was significantly worse in the Reference group (63%; p = 0.03). The composite rate of cardiac death and acute myocardial infarction in the Defer, Perform, and Reference groups was 3.3%, 7.9%, and 15.7%, respectively (p = 0.21 for Defer vs. Perform group; p = 0.003 for the Reference vs. both other groups). The percentage of patients free from chest pain at follow-up was not different between the Defer and Perform groups.

Conclusions

Five-year outcome after deferral of PCI of an intermediate coronary stenosis based on FFR ≥0.75 is excellent. The risk of cardiac death or myocardial infarction related to this stenosis is <1% per year and not decreased by stenting.

Abbreviations and Acronyms

AMI
acute myocardial infarction
FFR
fractional flow reserve
PCI
percutaneous coronary intervention
SPECT
single-photon emission computed tomography

Cited by (0)

This study was supported by an unrestricted grant from Radi Medical System, Uppsala, Sweden and the Friends of the Heart Foundation (Stichting Vrienden van het Hart), Eindhoven, the Netherlands.