Long-term follow-up after fractional flow reserve-guided treatment strategy in patients with an isolated proximal left anterior descending coronary artery stenosis.

Details

Serval ID
serval:BIB_777E1CCAE8BE
Type
Article: article from journal or magazin.
Collection
Publications
Title
Long-term follow-up after fractional flow reserve-guided treatment strategy in patients with an isolated proximal left anterior descending coronary artery stenosis.
Journal
Jacc. Cardiovascular Interventions
Author(s)
Muller O., Mangiacapra F., Ntalianis A., Verhamme K.M., Trana C., Hamilos M., Bartunek J., Vanderheyden M., Wyffels E., Heyndrickx G.R., van Rooij F.J., Witteman J.C., Hofman A., Wijns W., Barbato E., De Bruyne B.
ISSN
1876-7605 (Electronic)
ISSN-L
1936-8798
Publication state
Published
Issued date
2011
Peer-reviewed
Oui
Volume
4
Number
11
Pages
1175-1182
Language
english
Abstract
OBJECTIVES: This study sought to evaluate the long-term clinical outcome of patients with an angiographically intermediate left anterior descending coronary artery (LAD) stenosis in whom the revascularization strategy was based on fractional flow reserve (FFR).
BACKGROUND: When revascularization is based mainly on angiographic guidance, a number of hemodynamically nonsignificant stenoses will be revascularized.
METHODS: In 730 patients with a 30% to 70% isolated stenosis in the proximal LAD and no significant valvular disease, FFR measurements were obtained to guide treatment strategy. When FFR was ≥ 0.80, the patients (n = 564) were treated medically (medical group); when FFR was <0.80, the patients (n = 166) underwent a revascularization procedure (revascularization group; 13% coronary artery bypass graft surgery and 87% percutaneous coronary intervention). A 100% long-term clinical follow-up (median follow-up: 40 months) was obtained. The 5-year survival of the medical group was compared with that of a reference population. For each patient, 4 controls were selected from an age- and sex-matched control population.
RESULTS: The 5-year survival estimate was 92.9% in the medical group versus 89.6% in the controls (p = 0.74). The mean diameter stenosis was significantly smaller in the medical than in the revascularization group (39 ± 14% vs. 54 ± 13%, p < 0.0001), but there was a large overlap between both groups. The 5-year event-free survival estimates (death, myocardial infarction, and target vessel revascularization) were 89.7% and 68.5%, respectively (p < 0.0001).
CONCLUSIONS: Medical treatment of patients with a hemodynamically nonsignificant stenosis (FFR ≥ 0.80) in the proximal LAD is associated with an excellent long-term clinical outcome with survival at 5 years similar to an age- and sex-matched control population.
Keywords
Aged, Angioplasty, Balloon, Coronary/adverse effects, Angioplasty, Balloon, Coronary/mortality, hic" UI="D001530">Belgium, Cardiac Catheterization, Cardiovascular Agents/therapeutic use, Chi-Square Distribution, Coronary Angiography, Coronary Artery Bypass/adverse effects, Coronary Artery Bypass/mortality, Coronary Stenosis/diagnosis, Coronary Stenosis/mortality, Disease-Free Survival, Female, Fractional Flow Reserve, Myocardial, Hemodynamics, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Myocardial Infarction/etiology, hic" UI="D009426">Netherlands, Patient Selection, Predictive Value of Tests, Proportional Hazards Models, Registries, Risk Assessment, Risk Factors, Severity of Illness Index, Survival Rate, Time Factors, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
16/02/2015 17:49
Last modification date
20/08/2019 14:34
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