Fractional flow reserve to determine the appropriateness of angioplasty inmoderate coronary stenosis - A randomized trial

Background-PTCA of a coronary stenosis without documented ischemia at nonin vasive stress testing is often performed, but its benefit is unproven. Coro nary pressure-derived fractional flow reserve (FFR) is an invasive index of stenosis severity that is a reliable substitute for noninvasive stress tes ting. A value of 0.75 identifies stenoses with hemodynamic significance. Methods and Results-In 325 patients for whom PTCA was planned and who did n ot have documented ischemia, FFR of the stenosis was measured. If FFR was > 0.75, patients were randomly assigned to deferral (deferral group; n=91) or performance (performance group; n=90) of PTCA. If FFR was (0.75, PTCA was performed as planned (reference group; n=144). Clinical follow-up was obtai ned at 1, 3, 6, 12, and 24 months. Event-free survival was similar between the deferral and performance groups (92% versus 89% at 12 months and 89% ve rsus 83% at 24 months) but was significantly lower in the reference group ( 80% at 12 months and 78% at 24 months). In addition, the percentage of pati ents free from angina was similar between the deferral and performance grou ps (49% versus 50% at 12 months and 70% versus 51% at 24 months) but was si gnificantly higher in the reference group (67% at 12 and 80% at 24 months). Conclusions-In patients with a coronary stenosis without evidence of ischem ia, coronary pressure-derived FFR identifies those who will benefit from PT CA.