FFR / DEFER

Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study.

Pijls NH, van Schaardenburgh P, Manoharan G, Boersma E, Bech JW, van't Veer M, Bär F, Hoorntje J, Koolen J, Wijns W, de Bruyne B.

J Am Coll Cardiol. 2007 May 29; 49(21):2105-11.

OBJECTIVES:

The purpose of this study was to investigate the appropriateness of stenting a functionally nonsignificant stenosis.

METHODS:

• 325 patients
• 12 European and 2 Asian centers
• If FFR was ≥ 0.75, patients were randomly assigned to deferral (Defer group; n = 91) or performance (Perform group; n = 90) of PCI
• All patients scheduled for PCI of of a single angiographically significant de novo
• FFR was measured just before the planned intervention
• If FFR was < 0.75, PCI was performed as planned (Reference group; n = 144)
• Clinical follow-up was 5 years

SUMMARY:

• Complete follow-up was obtained in 98 % of the patients.
• Event-free survival was not different between the Defer group (80 %) and the Perform group (73 %; p = 0.52), but was significantly worse in the Reference group (63 %; p = 0.03).
• The composite rate of cardiac death and acute myocardial infarction in the Defer group was 3.3 % vs. 7.9 % in the Perfom group (p = 0.21)
• Cardiac death and MI in the Reference group was 15.7 %, respectively (p = 0.003 for the Reference vs. both other groups).
• The percentage of patients free from chest pain at follow-up was not different between the Defer and Perform groups.

Cardiac Death and Acute MI After 5 Years:

CONCLUSIONS:

Five-year outcome after deferral of PCI based on FFR ≥ 0.75 is excellent. The risk of cardiac death or myocardial infarction related to such a stenosis is < 1 % per year and not decreased by stenting. Therefore, stenting nonsignificant lesions does not improve the patient outcome.

DEFER 5 YEAR FOLLOW UP SUMMARY ( DOWNLOAD PDF )

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