Fractional flow reserve versus angiography for guiding percutaneous coronary intervention

BackgroundIn patients with multivessel coronary artery disease who are undergoing percutaneouscoronary intervention (PCI), coronary angiography is the standard method forguiding the placement of the stent. It is unclear whether routine measurement offractional flow reserve (FFR; the ratio of maximal blood flow in a stenotic artery tonormal maximal flow), in addition to angiography, improves outcomes.MethodsIn 20 medical centers in the United States and Europe, we randomly assigned 1005patients with multivessel coronary artery disease to undergo PCI with implantationof drug-eluting stents guided by angiography alone or guided by FFR measurementsin addition to angiography. Before randomization, lesions requiring PCI were identifiedon the basis of their angiographic appearance. Patients assigned to angiography-guided PCI underwent stenting of all indicated lesions, whereas those assignedto FFR-guided PCI underwent stenting of indicated lesions only if the FFR was 0.80or less. The primary end point was the rate of death, nonfatal myocardial infarction,and repeat revascularization at 1 year.ResultsThe mean (SD) number of indicated lesions per patient was 2.70.9 in the angiographygroup and 2.81.0 in the FFR group (P = 0.34). The number of stents used perpatient was 2.71.2 and 1.91.3, respectively (