Outcomes of Deferring Percutaneous Coronary Intervention Without Physiologic Assessment for Intermediate Coronary...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• Outcomes of deferring percutaneous coronary intervention (PCI) for intermediate coronary lesions without invasive physiologic assessment remain uncertain.
• Intermediate coronary lesions are defined as 50-70% diameter stenosis by angiography.

Purpose of the Study:

• To compare long-term outcomes between medical treatment and PCI for intermediate coronary lesions without invasive physiologic assessment.
• To evaluate the risk of major adverse cardiac events (MACE) in patients managed conservatively versus those undergoing PCI.

Main Methods:

• A randomized trial involving 899 patients with intermediate coronary lesions.
• Patients were assigned to a conservative group (deferred PCI) or an aggressive group (PCI performed).
• The primary endpoint was MACE (all-cause death, myocardial infarction, or ischemia-driven revascularization) at 3 years.

Main Results:

• The conservative group had a significantly higher incidence of MACE at 3 years compared to the aggressive group (13.8% vs. 9.3%, p=0.049).
• This difference was primarily driven by increased target intermediate lesion revascularization in the conservative group (6.5% vs. 1.1%, p<0.001).
• The conservative group also showed a higher incidence of cardiac death or MI and ischemia-driven revascularization between 1 and 3 years.

Conclusions:

• Medical therapy alone for intermediate coronary lesions, guided solely by angiography, is associated with a higher risk of MACE at 3 years.
• Performing PCI for intermediate lesions resulted in fewer MACE, mainly due to reduced revascularization needs.
• Invasive physiologic assessment may be crucial for guiding treatment decisions in intermediate coronary lesions.