Long-term follow-up after deferral of percutaneous transluminal coronary angioplasty of intermediate stenosis on the basis of coronary pressure measurement
GJ Bech,
B De Bruyne,
HJ Bonnier,
J Bartunek,
W Wijns,
K Peels,
GR Heyndrickx,
JJ Koolen,
and
NH Pijls
Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands. G.Bech@inter.NL.net
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. FFRmyo is 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 > or = 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 > or = 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.
This article has been cited by other articles:
|
|
|
|
 
S.-J. Park, J.-M. Ahn, and S.-J. Kang
Paradigm Shift to Functional Angioplasty: New Insights for Fractional Flow Reserve- and Intravascular Ultrasound-Guided Percutaneous Coronary Intervention
Circulation,
August 23, 2011;
124(8):
951 - 957.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Melikian, P. De Bondt, P. Tonino, O. De Winter, E. Wyffels, J. Bartunek, G. R. Heyndrickx, W. F. Fearon, N. H.J. Pijls, W. Wijns, et al.
Fractional Flow Reserve and Myocardial Perfusion Imaging in Patients With Angiographic Multivessel Coronary Artery Disease
J. Am. Coll. Cardiol. Intv.,
March 1, 2010;
3(3):
307 - 314.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Kern and H. Samady
Current Concepts of Integrated Coronary Physiology in the Catheterization Laboratory
J. Am. Coll. Cardiol.,
January 19, 2010;
55(3):
173 - 185.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. G. Kushner, M. Hand, S. C. Smith Jr, S. B. King III, J. L. Anderson, E. M. Antman, S. R. Bailey, E. R. Bates, J. C. Blankenship, D. E. Casey Jr, et al.
2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
J. Am. Coll. Cardiol.,
December 1, 2009;
54(23):
2205 - 2241.
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. G. Kushner, M. Hand, S. C. Smith Jr, S. B. King III, J. L. Anderson, E. M. Antman, S. R. Bailey, E. R. Bates, J. C. Blankenship, D. E. Casey Jr, et al.
2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Circulation,
December 1, 2009;
120(22):
2271 - 2306.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Hamilos, O. Muller, T. Cuisset, A. Ntalianis, G. Chlouverakis, G. Sarno, O. Nelis, J. Bartunek, M. Vanderheyden, E. Wyffels, et al.
Long-Term Clinical Outcome After Fractional Flow Reserve-Guided Treatment in Patients With Angiographically Equivocal Left Main Coronary Artery Stenosis
Circulation,
October 13, 2009;
120(15):
1505 - 1512.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Meimoun, T. Benali, F. Elmkies, S. Sayah, A. Luycx-Bore, L. Doutrelan, Z. Hamdane, J. Boulanger, and C. Tribouilloy
Prognostic value of transthoracic coronary flow reserve in medically treated patients with proximal left anterior descending artery stenosis of intermediate severity
Eur Heart J Cardiovasc Imaging,
January 1, 2009;
10(1):
127 - 132.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Crea, P. G. Camici, R. De Caterina, and G. A. Lanza
CHAPTER 17 Chronic Ischaemic Heart Disease
ESC Textbook of Cardiovascular Medicine,
January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Tobis, B. Azarbal, and L. Slavin
Assessment of Intermediate Severity Coronary Lesions in the Catheterization Laboratory
J. Am. Coll. Cardiol.,
February 27, 2007;
49(8):
839 - 848.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. L. Gould
Physiological severity of coronary artery stenosis
Am J Physiol Heart Circ Physiol,
December 1, 2006;
291(6):
H2583 - H2585.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Kern, A. Lerman, J.-W. Bech, B. De Bruyne, E. Eeckhout, W. F. Fearon, S. T. Higano, M. J. Lim, M. Meuwissen, J. J. Piek, et al.
Physiological Assessment of Coronary Artery Disease in the Cardiac Catheterization Laboratory: A Scientific Statement From the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology
Circulation,
September 19, 2006;
114(12):
1321 - 1341.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. W. Moses, G. W. Stone, E. Nikolsky, G. S. Mintz, G. Dangas, E. Grube, S. G. Ellis, A. J. Lansky, G. Weisz, M. Fahy, et al.
Drug-Eluting Stents in the Treatment of Intermediate Lesions: Pooled Analysis From Four Randomized Trials
J. Am. Coll. Cardiol.,
June 6, 2006;
47(11):
2164 - 2171.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Rieber, A. Huber, I. Erhard, S. Mueller, M. Schweyer, A. Koenig, T. M. Schiele, K. Theisen, U. Siebert, S. O. Schoenberg, et al.
Cardiac magnetic resonance perfusion imaging for the functional assessment of coronary artery disease: a comparison with coronary angiography and fractional flow reserve
Eur. Heart J.,
June 2, 2006;
27(12):
1465 - 1471.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Legalery, F. Schiele, M.-F. Seronde, N. Meneveau, H. Wei, K. Didier, M.-C. Blonde, F. Caulfield, and J.-P. Bassand
One-year outcome of patients submitted to routine fractional flow reserve assessment to determine the need for angioplasty
Eur. Heart J.,
December 2, 2005;
26(24):
2623 - 2629.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Kruger, K.-C. Koch, I. Kaumanns, M. W. Merx, P. Hanrath, and R. Hoffmann
Clinical Significance of Fractional Flow Reserve for Evaluation of Functional Lesion Severity in Stent Restenosis and Native Coronary Arteries
Chest,
September 1, 2005;
128(3):
1645 - 1649.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Namdar, T. F. Hany, P. Koepfli, P. T. Siegrist, C. Burger, C. A. Wyss, T. F. Luscher, G. K. von Schulthess, and P. A. Kaufmann
Integrated PET/CT for the Assessment of Coronary Artery Disease: A Feasibility Study
J. Nucl. Med.,
June 1, 2005;
46(6):
930 - 935.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, S. Silber, P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, J. Marco, J.-E. Nordrehaug, et al.
Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology
Eur. Heart J.,
April 2, 2005;
26(8):
804 - 847.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Lindstaedt, M. K. Fritz, A. Yazar, C. Perrey, A. Germing, P. H. Grewe, A. M. Laczkovics, A. Mugge, and W. Bojara
Optimizing revascularization strategies in patients with multivessel coronary disease: Impact of intracoronary pressure measurements
J. Thorac. Cardiovasc. Surg.,
April 1, 2005;
129(4):
897 - 903.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. K. Hau
Fractional flow reserve and complex coronary pathologic conditions
Eur. Heart J.,
May 1, 2004;
25(9):
723 - 727.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Ogawa, T. Ohkubo, R. Fukazawa, M. Kamisago, Y. Kuramochi, Y. Uchikoba, E. Ikegami, M. Watanabe, and Y. Katsube
Estimation of myocardial hemodynamics before and after intervention in children with kawasaki disease
J. Am. Coll. Cardiol.,
February 18, 2004;
43(4):
653 - 661.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Leesar, T. Abdul-Baki, N. I. Akkus, A. Sharma, T. Kannan, and R. Bolli
Use of fractional flow reserve versus stress perfusion scintigraphy after unstable angina: Effect on duration of hospitalization, cost, procedural characteristics, and clinical outcome
J. Am. Coll. Cardiol.,
April 2, 2003;
41(7):
1115 - 1121.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T Giesler, S Lamprecht, J-U Voigt, D Ropers, K Pohle, J Ludwig, F A Flachskampf, W G Daniel, and U Nixdorff
Long term follow up after deferral of revascularisation in patients with intermediate coronary stenoses and negative dobutamine stress echocardiography
Heart,
December 1, 2002;
88(6):
645 - 646.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. D. Miller
Coronary flow studies for risk stratification in multivessel disease: A physiologic bridge too far?
J. Am. Coll. Cardiol.,
March 6, 2002;
39(5):
859 - 863.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G J W Bech, H Droste, N H J Pijls, B De Bruyne, J J R M Bonnier, H R Michels, K H Peels, and J J Koolen
Value of fractional flow reserve in making decisions about bypass surgery for equivocal left main coronary artery disease
Heart,
November 1, 2001;
86(5):
547 - 552.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Schwartz and M. G. Bourassa
Evaluation of Patients With Chest Pain and Normal Coronary Angiograms
Arch Intern Med,
August 13, 2001;
161(15):
1825 - 1833.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Kern and B. Meier
Evaluation of the Culprit Plaque and the Physiological Significance of Coronary Atherosclerotic Narrowings
Circulation,
June 26, 2001;
103(25):
3142 - 3149.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. J. W. Bech, B. De Bruyne, N. H.J. Pijls, E. D. de Muinck, J. C.A. Hoorntje, J. Escaned, P. R. Stella, E. Boersma, J. Bartunek, J. J. Koolen, et al.
Fractional Flow Reserve to Determine the Appropriateness of Angioplasty in Moderate Coronary Stenosis : A Randomized Trial
Circulation,
June 19, 2001;
103(24):
2928 - 2934.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Meuwissen, S. A. J. Chamuleau, M. Siebes, C. E. Schotborgh, K. T. Koch, R. J. de Winter, M. Bax, A. de Jong, J. A. E. Spaan, and J. J. Piek
Role of Variability in Microvascular Resistance on Fractional Flow Reserve and Coronary Blood Flow Velocity Reserve in Intermediate Coronary Lesions
Circulation,
January 16, 2001;
103(2):
184 - 187.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. De Bruyne, N. H. J. Pijls, G. R. Heyndrickx, D. Hodeige, R. Kirkeeide, and K. L. Gould
Pressure-Derived Fractional Flow Reserve to Assess Serial Epicardial Stenoses : Theoretical Basis and Animal Validation
Circulation,
April 18, 2000;
101(15):
1840 - 1847.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Kern
Coronary Physiology Revisited : Practical Insights From the Cardiac Catheterization Laboratory
Circulation,
March 21, 2000;
101(11):
1344 - 1351.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Gruberg, G. S. Mintz, L. F. Satler, K. M. Kent, A. D. Pichard, and M. B. Leon
Intravascular imaging and physiologic lesion assessment to define critical coronary stenoses
Ann. Thorac. Surg.,
October 1, 1999;
68(4):
1547 - 1551.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. Abizaid, G. S. Mintz, R. Mehran, A. Abizaid, A. J. Lansky, A. D. Pichard, L. F. Satler, H. Wu, C. Pappas, K. M. Kent, et al.
Long-Term Follow-Up After Percutaneous Transluminal Coronary Angioplasty Was Not Performed Based on Intravascular Ultrasound Findings : Importance of Lumen Dimensions
Circulation,
July 20, 1999;
100(3):
256 - 261.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. J. W. Bech, N. H. J. Pijls, B. De Bruyne, K. H. Peels, H. R. Michels, H. J. R. M. Bonnier, and J. J. Koolen
Usefulness of Fractional Flow Reserve to Predict Clinical Outcome After Balloon Angioplasty
Circulation,
February 23, 1999;
99(7):
883 - 888.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Ferrari, B.a. Schnell, G. S. Werner, and H. R. Figulla
Safety of deferring angioplasty in patients with normal coronary flow velocity reserve
J. Am. Coll. Cardiol.,
January 1, 1999;
33(1):
82 - 87.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N H J Pijls and B De Bruyne
Coronary pressure measurement and fractional flow reserve
Heart,
December 1, 1998;
80(6):
539 - 542.
[Full Text]
|
|
|
|
