ABC | Volume 112, Nº1, January 2019

Original Article Quintella et al FFR-versus angiography-guided PCI in multivessel disease Arq Bras Cardiol. 2019; 112(1):40-47 1. Hachamovitch R, Rozanski A, Stone GW, Thomson LE, Friedman JD, et al. Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J. 2011;32(8):1012-24. 2. Aarnoudse WH, Botman KJ, Pijls NH. False-negative myocardial scintigraphy in balanced three-vessel disease, revealed by coronary pressure measurement. Int J Cardiovasc Intervent. 2003;5(2):67-71. 3. Fischer JJ, Samady H, McPherson JA, Sarembock IJ, Gimple LW, et al. Comparison between visual assessment and quantitative angiography versus fractional flow reserve for native coronary narrowings of moderate severity. Am J Cardiol. 2002;90(3):210-5. 4. De Bruyne B, FearonWF, Pijls NH, Barbato E, Tonino P, Piroth Z, et al; FAME 2 Trial Investigators. 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Cost-effectiveness of measuring fractional flow reserve to guide coronary interventions. Am Heart J. 2003;145(5):882-7. 10. Polanczyk CA, Wainstein MV, Ribeiro JP. Cost-effectiveness of sirolimus- eluting stents in percutaneous coronary interventions in Brazil. Arq Bras Cardiol. 2007;88(4):464-74. 11. Hachamovitch R, Kang X, Amanullah AM, Abidov A, Hayes SW, Friedman JD, et al. Prognostic implications of myocardial perfusion single- photon emission computed tomography in the elderly. Circulation. 2009;120(22):2197-206. 12. ShawLJ, BermanDS,MaronDJ, Hartigan PM, et al; COURAGE Investigators. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and AggressiveDrug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117(10):1283-91. 13. International Study of Comparative Health Effectiveness with Medical and Invasive Approaches. Executive summary of the ISCHEMIA trial 2013. [on-line]. [cited 2016 Jun 14]. Available from: <http://www.docsrush. net/2451891/executive-summary-of-the-ischemia-trial-february 2013.html 14. Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Gestão e Incorporação de Tecnologias References Study limitations The sample size was small, particularly due to limited funding resources, which made it difficult to obtain more consistent clinical data. Despite that, we did show significant differences in CE and reduction in TLR. Due to the long period of patient recruitment, some multivessel disease patients treated by angioplasty could not be recruited because of logistic and financial issues. Conclusions FFR-guided PCI, as compared with angiographic criteria,is a cost-effective strategy that reduces the number of lesions treated, stents, and the need for TVR in patients with multivessel diseases. Author contributions Conception and design of the research: Quintella EFQ, Ferreira E, Sant`Anna FM, Albuquerque DC; acquisition of data: Quintella EFQ, Ferreira E, Sant`Anna FM, Amorim B; analysis and interpretation of the data: Quintella EFQ, Ferreira E, Azevedo VMP, Araujo DV, Sant`Anna FM, Albuquerque DC; statistical analysis: Quintella EFQ, Azevedo VMP, Araujo DV; writing of the manuscript: Quintella EFQ, Ferreira E, Albuquerque DC; critical revision of the manuscript for intellectual content: Quintella EFQ, Ferreira E, Azevedo VMP, Araujo DV, Albuquerque DC. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding This study was funded by Fundação de Amparo à Pesquisa do Rio de Janeiro (FAPERJ). Study Association This article is part of the thesis of master submitted by Edgard Freitas Quintella, from Universidade do Estado do Rio de Janeiro. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Hospital Universitário Pedro Ernesto/UERJ under the protocol number 146.445. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 46