Long-term follow-up after deferral of coronary intervention based on myocardial fractional flow reserve measurement

OBJECTIVETo assess long-term results after deferring coronary intervention (percutaneous coronary intervention (PCI)) of an intermediate lesion with a value of myocardial fractional flow reserve (FFR) ≥0.75 in a ‘real life’ patient population with no respect to results of stress tests (if performed) or coronary disease extent. METHODSPCI of an intermediate lesion was deferred in a group of 85 consecutive patients (54 men, 61±10 years) on the basis of the result of FFR ≥0.75 (mean FFR, 0.89±0.06%). FFR was measured in 111 stenoses (mean diameter stenosis, 54±8%, left anterior descending coronary artery, 65 (58%), left circumflex coronary artery, 24 (22%), right coronary artery, 22 (20%). Multi-vessel disease (defined as visually assessed diameter reduction of more than 50% in at least two arteries of more than 1.5 mm diameter, supplying at least two of the three major coronary artery perfusion territories) was present in 67% of patients (one-vessel disease, 28 patients (33%), two-vessel disease, 39 patients (46%), three-vessel disease, 18 patients (21%). Recorded events during follow-up were as followsall-cause death, cardiac death, non-fatal myocardial infarction, ischemia-driven target lesion transcatheter revascularization (TLR) and coronary artery bypass graft (CABG). Angina class (Canadian Cardiovascular Society (CCS) classification) and the need for anti-anginal drugs were recorded. RESULTSFollow-up was completed in 85 patients (100%). Mean duration of follow-up was 22.6±6.6 months (range 4–33 months). Events occurred in 11 patients (13%). Seven patients died; this included two cardiac deaths. A non-fatal myocardial infarction occurred in one patient, one patient needed TLR and three patients underwent CABG. Estimated 33 month cardiac-event-free survival (Kaplan–Meier) was 91±4%. Angina class decreased [1.6±1.2 compared with 0.8±0.8 (P