Percutaneous coronary intervention versus medical therapy in patients with angina and grey-zone fractional flow reserve values: a randomised clinical trial

Hennigan, B. et al. (2020) Percutaneous coronary intervention versus medical therapy in patients with angina and grey-zone fractional flow reserve values: a randomised clinical trial. Heart, 106(10), pp. 714-715. (doi: 10.1136/heartjnl-2019-316075) (PMID:32114516) (PMCID:PMC7229900)

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Abstract

Introduction: There is conflicting evidence regarding the benefits of percutaneous coronary intervention (PCI) in patients with grey zone fractional flow reserve (GZFFR artery) values (0.75–0.80). The prevalence of ischaemia is unknown. We wished to define the prevalence of ischaemia in GZFFR artery and assess whether PCI is superior to optimal medical therapy (OMT) for angina control. Methods: We enrolled 104 patients with angina with 1:1 randomisation to PCI or OMT. The artery was interrogated with a Doppler flow/pressure wire. Patients underwent Magnetic Resonance Imaging (MRI) with follow-up at 3 and 12 months. The primary outcome was angina status at 3 months using the Seattle Angina Questionnaire (SAQ). Results: 104 patients (age 60±9 years), 79 (76%) males and 79 (76%) Left Anterior Descending (LAD) stenoses were randomised. Coronary physiology and SAQ were similar. Of 98 patients with stress perfusion MRI data, 17 (17%) had abnormal perfusion (≥2 segments with ≥25% ischaemia or ≥1 segment with ≥50% ischaemia) in the target GZFFR artery. Of 89 patients with invasive physiology data, 26 (28%) had coronary flow velocity reserve <2.0 in the target GZFFR artery. After 3 months of follow-up, compared with patients treated with OMT only, patients treated by PCI and OMT had greater improvements in SAQ angina frequency (21 (28) vs 10 (23); p=0.026) and quality of life (24 (26) vs 11 (24); p=0.008) though these differences were no longer significant at 12 months. Conclusions: Non-invasive evidence of major ischaemia is uncommon in patients with GZFFR artery. Compared with OMT alone, patients randomised to undergo PCI reported improved symptoms after 3 months but these differences were no longer significant after 12 months.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Shaukat, Dr Aadil and Rocchiccioli, Dr John and Ford, Thomas and McEntegart, Dr Margaret and Collison, Dr Damien and Hennigan, Dr Barry and Petrie, Professor Mark and Eteiba, Dr Hany and Oldroyd, Dr Keith and Corcoran, Dr David and Mangion, Dr Kenneth and McClure, Dr John and Hood, Dr Stuart
Authors: Hennigan, B., Berry, C., Collison, D., Corcoran, D., Eteiba, H., Good, R., McEntegart, M., Watkins, S., McClure, J., Mangion, K., Ford, T., Petrie, M. C., Hood, S., Rocchiccioli, P., Shaukat, A., Lindsay, M., and Oldroyd, K. G.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN:1355-6037
ISSN (Online):1468-201X
Published Online:29 February 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Heart 106(10): 714-715
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
171244A prospective comparison of the diagnostic utility of invasive coronary physiological indices and quantitative perfusion MRI in patients with coronary heart disease...Keith OldroydBritish Heart Foundation (BHF)PG/14/97/31263Institute of Cardiovascular & Medical Sciences