Long-Term DEFER-DES Outcomes Support FFR-Guided DES Treatment of Intermediate Coronary Stenosis

December 11, 2015—Five-year clinical outcomes of the DEFER-DES trial were published by Sang Hyun Park, MD, et al in Circulation: Cardiovascular Interventions. The DEFER-DES study from Korea aimed to compare the long-term clinical outcomes between fractional flow reserve (FFR)–guided and routine drug-eluting stent (DES) implantation in patients with an intermediate coronary stenosis.

The investigators concluded that in lesions with angiographically intermediate stenosis, FFR guidance provides a tailored approach, which is at least as good as an angiography-guided routine DES implantation strategy and avoids unnecessary stenting with a DES in a considerable number of patients.

As summarized in Circulation: Cardiovascular Interventions, a total of 229 patients with an angiographically intermediate coronary stenosis were randomly assigned to the FFR-guided or routine DES implantation group. 

For the FFR-guided group (n = 114), treatment strategy was determined according to the target vessel FFR (FFR < .75: DES implantation [FFR-DES group]; FFR ≥ .75: deferral of stenting [FFR-Defer group]). The routine DES group underwent DES implantation without FFR measurement (n = 115). 

The primary endpoint was the incidence of major adverse cardiac events, a composite of cardiac death, myocardial infarction, and target lesion revascularization. 

Of lesions assigned to FFR-guided strategy, only one quarter had functional significance (FFR < .75). At 2-year follow-up, the cumulative incidence of major adverse cardiac events was 7.9% ± 2.5% in the FFR-guided group and 8.8% ± 2.7% in routine DES group (P = .80). At 5-year follow-up, the cumulative incidence of major adverse cardiac events was 11.6% ± 3.0% and 14.2% ± 3.3% for the FFR-guided group and the routine DES group, respectively (P = .55). There was no difference in major adverse cardiac events rates between the two groups at up to 5-year follow-up (hazard ratio, 1.25; 95% confidence interval, 0.60–2.6), reported the investigators in Circulation: Cardiovascular Interventions.