Percutaneous coronary intervention in stable coronary artery disease

2014 ◽  
Vol 155 (49) ◽  
pp. 1952-1959
Author(s):  
Zsolt Piróth
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
Artery Disease

Percutaneous coronary intervention is a well-established symptomatic therapy of stable coronary artery disease. Using a literature search with special emphasis on the newly-published FAME 2 trial data, the author wanted to explore why percutaneous coronary intervention fails to reduce mortality and myocardial infarction in stable coronary artery disease, as opposed to surgical revascularisation. In the FAME 2 trial, fractional flow reserve-guided percutaneous coronary intervention with second generation drug eluting stents showed a significant reduction in the primary composite endpoint of 2-year mortality, myocardial infarction and unplanned hospitalization with urgent revascularisation as compared to medical therapy alone. In addition, landmark analysis showed that after 8 days, mortality and myocardial infarction were significantly reduced. The author concludes that percutaneous coronary intervention involving fractional flow reserve guidance and modern stents offers symptomatic, as well as prognostic benefit. Orv. Hetil., 2014, 155(49), 1952–1959.

scholarly journals Placebo-Controlled Efficacy of Percutaneous Coronary Intervention for Focal and Diffuse Patterns of Stable Coronary Artery Disease

2021 ◽  
Author(s):  
Christopher A. Rajkumar ◽  
Matthew Shun-Shin ◽  
Henry Seligman ◽  
Yousif Ahmad ◽  
Takayuki Warisawa ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Stress Echocardiography ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
End Points ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
Artery Disease

Background: Physiological assessment with pressure wire pullback can characterize coronary artery disease (CAD) with a focal or diffuse pattern. However, the clinical relevance of this distinction is unknown. We use data from the ORBITA trial (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) to test if the pattern of CAD predicts the placebo-controlled efficacy of percutaneous coronary intervention (PCI) on stress echocardiography ischemia and symptom end points. Methods: One hundred sixty-four patients in ORBITA underwent blinded instantaneous wave-free ratio (iFR) pullback assessment before randomization. Focal disease was defined as a ≥0.03 iFR unit drop within 15 mm, rather than over a longer distance. Analyses were performed using regression modeling. Results: In the PCI arm (n=85), 48 were focal and 37 were diffuse. In the placebo arm (n=79), 35 were focal and 44 were diffuse. Focal stenoses were associated with significantly lower fractional flow reserve (FFR) and iFR values than diffusely diseased vessels (mean FFR and iFR, focal 0.60±0.15 and 0.65±0.24, diffuse 0.78±0.10 and 0.88±0.08, respectively, P <0.0001). With adjustment for this difference, PCI for focal stenoses resulted in significantly greater reduction in stress echo ischemia than PCI for diffuse disease ( P <0.05). The effect of PCI on between-arm pre-randomization adjusted exercise time was 9.32 seconds (95% CI, −17.1 to 35.7 seconds; P =0.487). When stratified for pattern of disease, there was no detectable difference between focal and diffuse CAD ( P interaction=0.700). PCI improved Seattle Angina Questionnaire angina frequency score and freedom from angina more than placebo ( P =0.034; P =0.0035). However, there was no evidence of interaction between the physiological pattern of CAD and these effects ( P interaction=0.436; P interaction=0.908). Conclusions: PCI achieved significantly greater reduction of stress echocardiography ischemia in focal compared with diffuse CAD. However, for symptom end points, no such difference was observed. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT02062593.

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