000			03119nam a2200265 4500
001			ESSALUD
005			20260804122252.0
007			ta
008			t pe ||||| |||| 00| 0 spa d
040			_aBMG
041			_aeng
100			_aFearon, William F. _eAutor _953637
245			_aAngiography-derived fractional flow reserve to guide PCI
300			_apáginas: 9-19
520			_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.
650			_aCARDIOLOGÍA GENERAL _953638
650			_aENFERMEDAD CORONARIA _914895
650			_aINFARTO DE MIOCARDIO _913202
700			_aJeremias, Allen _953639
700			_aWitberg, Guy _953640
700			_aAl-Lamee, Rasha _953641
700			_aCohen, David J. _953642
773	0		_022717 _922634 _dMassachusetts NEJM Group _oNEJM001 _tThe New England Journal of Medicine _wESSALUD _x0028-4793
942			_cARTICULOS _e2026-07-31 _zsqb
999			_c22720 _d22720