Five-year follow-up in patients after therapy stratification based on intracoronary pressure measurement

Johannes Rieber, Philip Jung, Andreas Koenig, Thomas Schiele, Michael Shapiro, Udo Hoffmann, Volker Klauss

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Invasive coronary angiography (ICA) alone fails to accurately select patients with intermediate stenoses who should be treated by percutaneous coronary intervention (PCI). Previous studies have demonstrated the usefulness of fractional flow reserve (FFR) for identifying patients in whom deferring an intended PCI would be more beneficial than performing the planned procedure. The long-term safety of FFR-based therapy stratification, however, remains unknown. Therefore, the aim of this study was to retrospectively evaluate the long-term safety of an FFR-based therapy stratification in patients with intermediate coronary lesions detected by ICA. Methods: We included 56 patients presenting with a 50% to 75% angiographic stenosis by visual assessment on ICA, with negative, inconclusive, or no stress test, and in whom the intended PCI was deferred based on the result of the FFR measurement (ie, FFR ≥0.75). The occurrence of major adverse cardiac events during a 5-year follow-up period was recorded. Results: A complete 5-year follow-up was available in all patients. Mean follow-up was 1868 ± 380 days. During follow-up, 16 events (1 cardiac death, 4 noncardiac deaths, 11 revascularization procedures) occurred. The combined rate of cardiac death and nonfatal myocardial infarction was 1.8% over 5 years. Nine PCI procedures (5 target vessel, 4 nontarget vessel) were performed during follow-up based on objective signs of ischemia. The angina status was not different between inclusion and the 5-year follow-up. Conclusion: Deferring PCI in patients without critical reduction in FFR may be a safe option during long-term follow-up.

Original languageEnglish (US)
Pages (from-to)403-409
Number of pages7
JournalAmerican Heart Journal
Volume153
Issue number3
DOIs
StatePublished - Mar 2007
Externally publishedYes

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Percutaneous Coronary Intervention
Pressure
Coronary Angiography
Pathologic Constriction
Therapeutics
Safety
Exercise Test
Ischemia
Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Five-year follow-up in patients after therapy stratification based on intracoronary pressure measurement. / Rieber, Johannes; Jung, Philip; Koenig, Andreas; Schiele, Thomas; Shapiro, Michael; Hoffmann, Udo; Klauss, Volker.

In: American Heart Journal, Vol. 153, No. 3, 03.2007, p. 403-409.

Research output: Contribution to journalArticle

Rieber, Johannes ; Jung, Philip ; Koenig, Andreas ; Schiele, Thomas ; Shapiro, Michael ; Hoffmann, Udo ; Klauss, Volker. / Five-year follow-up in patients after therapy stratification based on intracoronary pressure measurement. In: American Heart Journal. 2007 ; Vol. 153, No. 3. pp. 403-409.
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abstract = "Background: Invasive coronary angiography (ICA) alone fails to accurately select patients with intermediate stenoses who should be treated by percutaneous coronary intervention (PCI). Previous studies have demonstrated the usefulness of fractional flow reserve (FFR) for identifying patients in whom deferring an intended PCI would be more beneficial than performing the planned procedure. The long-term safety of FFR-based therapy stratification, however, remains unknown. Therefore, the aim of this study was to retrospectively evaluate the long-term safety of an FFR-based therapy stratification in patients with intermediate coronary lesions detected by ICA. Methods: We included 56 patients presenting with a 50{\%} to 75{\%} angiographic stenosis by visual assessment on ICA, with negative, inconclusive, or no stress test, and in whom the intended PCI was deferred based on the result of the FFR measurement (ie, FFR ≥0.75). The occurrence of major adverse cardiac events during a 5-year follow-up period was recorded. Results: A complete 5-year follow-up was available in all patients. Mean follow-up was 1868 ± 380 days. During follow-up, 16 events (1 cardiac death, 4 noncardiac deaths, 11 revascularization procedures) occurred. The combined rate of cardiac death and nonfatal myocardial infarction was 1.8{\%} over 5 years. Nine PCI procedures (5 target vessel, 4 nontarget vessel) were performed during follow-up based on objective signs of ischemia. The angina status was not different between inclusion and the 5-year follow-up. Conclusion: Deferring PCI in patients without critical reduction in FFR may be a safe option during long-term follow-up.",
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N2 - Background: Invasive coronary angiography (ICA) alone fails to accurately select patients with intermediate stenoses who should be treated by percutaneous coronary intervention (PCI). Previous studies have demonstrated the usefulness of fractional flow reserve (FFR) for identifying patients in whom deferring an intended PCI would be more beneficial than performing the planned procedure. The long-term safety of FFR-based therapy stratification, however, remains unknown. Therefore, the aim of this study was to retrospectively evaluate the long-term safety of an FFR-based therapy stratification in patients with intermediate coronary lesions detected by ICA. Methods: We included 56 patients presenting with a 50% to 75% angiographic stenosis by visual assessment on ICA, with negative, inconclusive, or no stress test, and in whom the intended PCI was deferred based on the result of the FFR measurement (ie, FFR ≥0.75). The occurrence of major adverse cardiac events during a 5-year follow-up period was recorded. Results: A complete 5-year follow-up was available in all patients. Mean follow-up was 1868 ± 380 days. During follow-up, 16 events (1 cardiac death, 4 noncardiac deaths, 11 revascularization procedures) occurred. The combined rate of cardiac death and nonfatal myocardial infarction was 1.8% over 5 years. Nine PCI procedures (5 target vessel, 4 nontarget vessel) were performed during follow-up based on objective signs of ischemia. The angina status was not different between inclusion and the 5-year follow-up. Conclusion: Deferring PCI in patients without critical reduction in FFR may be a safe option during long-term follow-up.

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