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Stent Placement Technique Leads to Superior Outcomes

Death rate is lower when implantation is guided by fractional flow reserve and angiography

WEDNESDAY, Jan. 14 (HealthDay News) -- In patients with multivessel coronary artery disease who undergo percutaneous coronary intervention with drug-eluting stents, routine measurement of fractional flow reserve in addition to angiography is associated with significantly improved outcomes compared to angiography alone, according to a report published in the Jan. 15 issue of the New England Journal of Medicine.

Pim A.L. Tonino, M.D., of the Catharina Hospital in Eindhoven, the Netherlands, and colleagues randomly assigned 1,005 patients to undergo stent implantation guided by angiography alone or by fractional flow reserve measurements in addition to angiography.

After one year, the researchers found that the primary end point -- rate of death, non-fatal myocardial infarction, and repeat revascularization -- was significantly lower in the fractional flow reserve group than in the angiography-alone group (13.2 percent versus 18.3 percent) and that the fractional flow reserve group also was more likely to be angina-free (81 percent versus 78 percent).

"History has shown us that not all statistically significant results from studies of this size are repeatable," states the author of an accompanying editorial. "It is likely, however, on the basis of results from other relevant trials…that the investigators are on to something. A validation study addressing the issues raised here would be very helpful for the interventional cardiology community."

This study was supported by grants from Radi Medical Systems, Medtronic and Stichting Vrienden van het Haart Zuidoost Brabant. Several authors of the study and editorial report financial ties to medical companies.

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