Doppler and angiographic endpoints: lessons from FROST and DESTINI

The strategy of provisional stenting has been guided by functional evaluation (coronary flow reserve) and anatomic evaluation (quantitative coronary angioplasty). Two trials, FROST and DESTINI, compared provisional and systematic stenting strategies. Interestingly, they showed that 43-52% of patients were not stented on the basis of angiographic and Doppler guidance. Moreover, there was no significant difference in the occurrence of restenosis (FROST) and major cardiac events (DESTINI). In conclusion, although provisional stenting appears safe and efficacious, this strategy is overshadowed by the concept of direct stenting which can shorten and simplify the procedure of angioplasty.