Key result
PCI fails to reduce overall VOCE vs medical therapy, showing benefit only in high-risk lesions.
Why the study?
Current guidelines recommend deferring PCI for angiographically intermediate coronary lesions without functional ischemia (FFR >0.80), but the long-term safety of this strategy and the potential role of preventive PCI in high-risk anatomical subsets remain uncertain.
Does percutaneous coronary intervention plus medical therapy reduce vessel-oriented composite endpoints compared to medical therapy alone in patients with chronic coronary syndrome and functionally non-ischemic intermediate lesions?
Cohort (n=410)
No
Does percutaneous coronary intervention plus medical therapy reduce vessel-oriented composite endpoints compared to medical therapy alone in patients with chronic coronary syndrome and functionally non-ischemic intermediate lesions?
While PCI did not significantly reduce long-term vessel-oriented adverse events across all functionally non-ischemic intermediate lesions, it provided substantial long-term clinical benefit in lesions presenting with high-risk anatomical features (stenosis ≥70%, multivessel disease, and LAD involvement).
Background Current guidelines recommend deferring percutaneous coronary intervention (PCI) for angiographically intermediate coronary lesions without functional ischemia (FFR >0.80). However, the long-term safety of this strategy and the potential role of preventive PCI in high-risk anatomical subsets remain uncertain. Objectives This study aimed to compare long-term vessel-level outcomes between PCI and medical therapy (MT) for functionally non-ischemic intermediate lesions, identify anatomical predictors of events under MT, and evaluate the net clinical benefit of preventive PCI. Methods In this single-center, retrospective cohort study, we analyzed 550 functionally non-ischemic intermediate lesions from 410 patients with chronic coronary syndrome. Lesions were managed by either PCI plus MT or MT alone based on clinician preference, and angiography-derived FFR was computed retrospectively. The primary endpoint was the vessel-oriented composite endpoint (VOCE), a composite of vessel-specific myocardial infarction and ischemia-driven target vessel revascularization. Results During a median follow-up of 9 years, PCI did not reduce the risk of VOCE in the overall cohort compared with MT (9.1% vs. 13.3%; HR 0.635, 95% CI 0.379-1.057, P=0.081). However, significant heterogeneity was observed. Among lesions with high-risk anatomical features (stenosis ≥70%, multivessel disease, and left anterior descending artery involvement), PCI was associated with a significantly lower risk of VOCE (9.4% vs. 28.2%; HR 0.297, 95% CI 0.164-0.535, P<0.0001). The number needed to treat to prevent one VOCE event in this high-risk subgroup was 4 at 9 years, with a favorable number needed to harm of 9, indicating a positive net clinical benefit. Conclusions A uniform strategy of deferring PCI for all functionally non-ischemic intermediate lesions may not be optimal in the long term, and lesions with high-risk anatomic features may still benefit from PCI.
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Xuan et al. (2026) conducted a cohort in Chronic coronary syndrome with functionally non-ischemic intermediate lesions (n=410). Percutaneous coronary intervention (PCI) plus medical therapy vs. Medical therapy (MT) alone was evaluated on Vessel-oriented composite endpoint (VOCE: vessel-specific myocardial infarction and ischemia-driven target vessel revascularization) (HR 0.635, 95% CI 0.379-1.057, p=0.081). PCI did not significantly reduce VOCE overall vs medical therapy (9.1% vs 13.3%; HR 0.635, P=0.081), but lowered risk in high-risk anatomical lesions (9.4% vs 28.2%; HR 0.297, P<0.0001).
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