The effect of drug eluting stents on cardiovascular events in patients with intermediate lesions and borderline fractional flow reserve

Shahar Lavi, Charanjit S. Rihal, Eric H. Yang, Amir Ali Fassa, Ahmad Elesber, Ryan J. Lennon, Verghese Mathew, Holmes R. David, Amir Lerman

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

Objective: To assess the role of fractional flow reserve (FFR) in guiding therapy in the drug eluting stent (DES) era. Background: FFR is a useful index for evaluation of the physiological significance of angiographically indeterminate coronary artery lesions. However, its role in the DES era is unknown. Methods: Long term outcome of 281 patients with angiographically indeterminate coronary lesions and borderline FFR (0.75 ≤ FFR < 0.9) was obtained. The outcome of patients who had a DES placed (n = 58), was compared with that of consecutive patients with borderline FFR that were treated by PCI with bare metal stents (BMS, n < 58), or were deferred from revascularization (n = 165). Results: FFR was significantly higher in the deferred group (median and IQR); 0.85 (0.82 to 0.88) compared with the BMS (0.78; 0.76 to 0.82) and the DES (0.79; 0.77 to 0.82), P < 0.001. Pretreatment FFR was a significant determinant of long term event rates in the deferred patients (P = 0.002) but had no effect in patients treated by PCI. In the deferred group, there were fewer events (death, myocardial infarction, target vessel revascularization) compared with the BMS group; but no significant difference was observed between the DES and the deferred groups. Conclusions: In borderline FFR, long term outcome after PCI with BMS is inferior to conservative therapy or PCI with DES. While conservative management is preferable in these patients, PCI with DES may be considered in specific circumstances.

Original languageEnglish (US)
Pages (from-to)525-531
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume70
Issue number4
DOIs
StatePublished - Oct 1 2007

Keywords

  • Fractional flow reserve
  • Outcome
  • Stents

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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