The utility of PCI in stable CAD is unclear. Fractional flow reserve (FFR) may be used to stratify patients between those who will benefit from PCI from those who will not.
A randomized clinical trial published in NEJM examined this question. Patients with FFR<0.8 were randomized to PCI or medical therapy. Although the primary endpoint included a soft endpoint (revascularization) there was significant decrease in the primary endpoint among patients who underwent PCI (8.1 vs 19.5%). Further, the hard endpoints (death or nonfatal myocardial infarction) were also reduced significantly in FFR patients (4.6% vs 8.0%). Quite interestingly, the individuals with FFR greater than 0.8 met primary endpoint as often as those with FFR<0.8 and PCI (8.1 vs. 9.0%) although this was not a direct comparison group.
Interesting results! ……… Perhaps practice changing?
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