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이달의 kcj Hot Article / 2025년 3월 Outcomes of Deferring Percutaneous Coronary Intervention Without Physiologic Assessment for Intermediate Coronary Lesions
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.
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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