LONG-TERM FOLLOW-UP AFTER DEFERRAL OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY OF INTERMEDIATE STENOSIS ON THE BASIS OF CORONARY PRESSURE MEASUREMENT

Objectives. This study sought to determine the safety of deferral of p ercutaneous transluminal coronary angioplasty (PICA) of angiographical ly intermediate but functionally nonsignificant stenosis, as assessed by coronary pressure measurement and myocardial fractional flow reserv e (FFRmyo). Background. Decision making in patients with chest pain an d intermediate coronary stenosis remains difficult. In these cases it is unclear whether the risk of an intervention and the potentially sub sequent restenosis outweigh the future risk of an event if the lesion remains untreated. FFRmyo is a lesion-specific functional index of epi cardial stenosis severity that accurately distinguishes stenoses assoc iated with inducible ischemia. Methods. Retrospective analysis and fol low-up was performed in 100 consecutive patients referred to our cente rs for PTCA of an intermediate stenosis but in whom the planned interv ention was deferred on the basis of an FFRmyo greater than or equal to 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 p atients remained free of any coronary events, and their average Canadi an Cardiovascular Society class decreased from 2.0 +/- 1.2 at baseline to 0.7 +/- 0.9 at follow-np (p < 0.0001). A coronary event occurred i n eight patients and was target-vessel related in four. Conclusions. I n patients with chest pain referred for PTCA of an intermediate stenos is, deferral of the intervention on the basis of an FFRmyo greater tha n or equal to 0.75 is safe and is associated with a much lower clinica l event rate than if the procedure had been performed as initially pla nned in these patients. (C) 1998 by the American College of Cardiology .