03116nam a2200265   4500001000800000005001700008007000300025008004100028040000800069041000800077100003800085245006100123300002200184520228100206650003302487650003202520650003202552700002802584700002402612700002802636700002802664773011002692942003102802999001702833ESSALUD20260804122252.0ta      t        pe ||||| |||| 00| 0 spa d  aBMG  aeng  aFearon, William F. eAutor953637  aAngiography-derived fractional flow reserve to guide PCI  apáginas: 9-19    aBackground: Assessing intermediate coronary lesions with an intracoronary pressure wire improves clinical outcomes in patients undergoing cardiac catheterization and percutaneous coronary intervention (PCI). However, clinical use of pressure-wire–based physiological assessment remains low. Measurement of fractional flow reserve (FFR) derived from coronary angiographic images alone correlates well with pressure-wire–based FFR measurements and may simplify procedures, but its effect on clinical outcomes is unknown.
Methods: In this international noninferiority trial, we randomly assigned patients undergoing coronary angiography who were found to have at least one intermediate coronary stenosis to physiological assessment with measurements derived from angiographic images (FFRangio) or with pressure-wire–based measurements. The primary end point was a composite of death, myocardial infarction, or unplanned, clinically indicated coronary revascularization at 1 year. The noninferiority margin was 3.5 percentage points.

Results: A total of 1930 patients were randomly assigned to physiological assessment with FFRangio (FFRangio group; 965 patients) or a pressure-wire–based approach (pressure-wire group; 965 patients). The mean age of the patients was 68.4 years, and 25.0% of the patients were women. At 1 year, a primary end-point event had occurred in 64 patients (Kaplan–Meier estimate, 6.9%) in the FFRangio group and 65 patients (Kaplan–Meier estimate, 7.1%) in the pressure-wire group (hazard ratio, 0.98; 95% confidence interval, 0.70 to 1.39; difference, −0.2 percentage points; upper boundary of the one-sided 97.5% confidence interval, 2.1 percentage points; P<0.001 for noninferiority). There were no apparent differences between the groups with respect to the incidence of bleeding, acute kidney injury, or procedure-related adverse events.
Conclusions: Among patients with intermediate coronary-artery lesions undergoing physiological assessment in the cardiac catheterization laboratory, an angiography-guided strategy involving FFRangio was noninferior to a pressure-wire–guided strategy with respect to a composite end point of death, myocardial infarction, or unplanned clinically indicated coronary revascularization at 1 year.
  aCARDIOLOGÍA GENERAL953638  aENFERMEDAD CORONARIA914895  aINFARTO DE MIOCARDIO913202  aJeremias, Allen 953639  aWitberg, Guy953640  aAl-Lamee, Rasha 953641  aCohen, David J. 9536420 022717922634dMassachusetts NEJM GroupoNEJM001tThe New England Journal of Medicine wESSALUDx0028-4793  cARTICULOSe2026-07-31zsqb  c22720d22720