April 30, 2026Journal of the American College of Cardiology
Percutaneous Coronary Intervention of Functionally Nonsignificant Stenosis
Why the study?
PCI of an intermediate stenosis without evidence of ischemia is often performed, but its benefit is unproven.
Does deferral of PCI compared to performance of PCI improve or maintain event-free survival in patients with intermediate coronary stenosis and FFR ≥0.75?
Population
325 patients scheduled for PCI of an intermediate stenosis
Comparison
Deferral vs performance of PCI in patients with FFR >or =0.75 (plus reference group with FFR <0.75)
Design
Randomized controlled trial
Follow-up
5 years
Authors
Discussion
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Overview
Safe to defer PCI for FFR ≥0.75 intermediate stenoses; leaves open broader FFR adoption pending contemporary randomized confirmation.
Key Points
- To evaluate the safety and clinical benefit of stenting versus deferring intervention in patients with functionally nonsignificant intermediate coronary stenosis.
- Randomized trial of 325 patients scheduled for percutaneous coronary intervention (PCI) of an intermediate stenosis with fractional flow reserve (FFR) measured before intervention.
- Patients with FFR ≥0.75 were randomly assigned to deferral (n=91) or performance (n=90) of PCI, while patients with FFR <0.75 underwent PCI as planned (Reference group, n=144).
- Patients were monitored over a 5-year clinical follow-up period, with complete follow-up achieved in 98% of participants.
- Five-year event-free survival was 80% in the Defer group versus 73% in the Perform group (p=0.52), while the Reference group achieved 63% (p=0.03).
- Composite cardiac death and acute myocardial infarction occurred in 3.3% of the Defer group, 7.9% of the Perform group (p=0.21 for Defer vs Perform), and 15.7% of the Reference group (p=0.003 vs both other groups).
- Rates of patients free from chest pain at 5 years were not significantly different between the Defer and Perform groups.
Structured PICO
Does deferral of PCI compared to performance of PCI improve or maintain event-free survival in patients with intermediate coronary stenosis and FFR ≥0.75?
P
Population
325 patients scheduled for percutaneous coronary intervention (PCI) of an intermediate stenosis, including 181 patients with fractional flow reserve (FFR) ≥0.75 randomized to deferral or performance of PCI, and 144 patients with FFR <0.75 in a reference group.
I
Intervention
Deferral of percutaneous coronary intervention (PCI) for functionally nonsignificant stenosis (FFR ≥0.75)
C
Comparator
Performance of percutaneous coronary intervention (PCI) for functionally nonsignificant stenosis (FFR ≥0.75)
O
Outcome
Event-free survival at 5 yearscomposite
Deferring PCI for intermediate coronary stenoses that are functionally nonsignificant (FFR ≥0.75) is safe and yields excellent 5-year outcomes without the need for stenting.
Cite This Study
Pijls et al. (2007) studied this question.