이달의 증례
| Outcomes of Deferring Percutaneous Coronary Intervention Without Physiologic Assessment for Intermediate Coronary Lesions | |||
|---|---|---|---|
| 년도 | 2025년 3월 | ||
| 카테고리 | 이달의 kcj Hot Article | ||
| 저자 | Jihoon Kim, MD,1,* Seong-Hoon Lim, MD, PhD,2,* Joo-Yong Hahn, MD, PhD,1 Jin-Ok Jeong, MD, PhD,3 Yong Hwan Park, MD, PhD,4 Woo Jung Chun, MD, PhD,4 Ju Hyeon Oh, MD, PhD,4 Dae Kyoung Cho, MD, PhD,5 Yu Jeong Choi, MD, PhD,6 Eul-Soon Im, MD, PhD,7 Kyung-Heon Won, MD, PhD,8 Sung Yun Lee, MD, PhD,9 Sang-Wook Kim, MD, PhD,10 Ki Hong Choi, MD,1 Joo Myung Lee, MD, PhD,1 Taek Kyu Park, MD, PhD,1 Jeong Hoon Yang, MD, PhD,1 Young Bin Song, MD, PhD,1 Seung-Hyuk Choi, MD, PhD,1 and Hyeon-Cheol Gwon, MD, PhD1 | ||
| 소속 | 1Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2Division of Cardiovascular Medicine, Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea. 3Cardiovascular Center, Chungnam National University Hospital, Chungnam National University, Daejeon, Korea. 4Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea. 5Heart-Well Cardiology Clinic, Jeju, Korea. 6Division of Cardiology, Eulji Medical Center, Eulji University, Daejeon, Korea. 7Division of Cardiology, Dongsuwon General Hospital, Suwon, Korea. 8Department of Cardiology, Cardiovascular Center, Seoul Medical Center, Seoul, Korea. 9Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea. 10Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea. | ||
| 첨부파일 1 | KCJ-23-223 GA v2 복사.jpg | ||
- 관리자
- 등록일 : 2025.03.18
- Hit 374
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.
Trial Registration
ClinicalTrials.gov Identifier: NCT00743899
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