Outcomes of Deferring Percutaneous Coronary Intervention Without Physiologic Assessment for Intermediate Coronary Lesions
- Author:
Jihoon KIM
1
;
Seong-Hoon LIM
;
Joo-Yong HAHN
;
Jin-Ok JEONG
;
Yong Hwan PARK
;
Woo Jung CHUN
;
Ju Hyeon OH
;
Dae Kyoung CHO
;
Yu Jeong CHOI
;
Eul-Soon IM
;
Kyung-Heon WON
;
Sung Yun LEE
;
Sang-Wook KIM
;
Ki Hong CHOI
;
Joo Myung LEE
;
Taek Kyu PARK
;
Jeong Hoon YANG
;
Young Bin SONG
;
Seung-Hyuk CHOI
;
Hyeon-Cheol GWON
Author Information
- Publication Type:Original Research
- From:Korean Circulation Journal 2025;55(3):185-195
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background and Objectives:Outcomes of deferring percutaneous coronary intervention (PCI) without invasive physiologic assessment for intermediate coronary lesions is uncertain.We sought to compare long-term outcomes between medical treatment and PCI of intermediate lesions without invasive physiologic assessment.
Methods:A total of 899 patients with intermediate coronary lesions between 50% and 70% diameter-stenosis were randomized to the conservative group (n=449) or the aggressive group (n=450). For intermediate lesions, PCI was performed in the aggressive group, but was deferred in the conservative group. The primary endpoint was major adverse cardiac events (MACE, a composite of all-cause death, myocardial infarction [MI], or ischemia-driven any revascularization) at 3 years.
Results:The number of treated lesions per patient was 0.8±0.9 in the conservative group and 1.7±0.9 in the aggressive group (p=0.001). At 3 years, the conservative group had a significantly higher incidence of MACE than the aggressive group (13.8% vs. 9.3%; hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.00–2.21; p=0.049), mainly driven by revascularization of target intermediate lesion (6.5% vs. 1.1%; HR, 5.69; 95% CI, 2.20–14.73;p<0.001). Between 1 and 3 years after the index procedure, compared to the aggressive group, the conservative group had significantly higher incidence of cardiac death or MI (3.2% vs.0.7%; HR, 4.34; 95% CI, 1.24–15.22; p=0.022) and ischemia-driven any revascularization.
Conclusions:For intermediate lesions, medical therapy alone, guided only by angiography, was associated with a higher risk of MACE at 3 years compared with performing PCI, mainly due to increased revascularization.
