Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Long-Term Clinical Outcomes After IFR- vs FFR-Guided Coronary Revascularization : Insights From the SWEDEHEART National Registry

Götberg, Matthias LU ; Berntorp, Karolina LU orcid ; Jeremias, Allen ; Yndigegn, Troels LU ; von Koch, Sacharias LU orcid ; Linder, Rickard ; Koul, Sasha LU ; Fröbert, Ole ; Erlinge, David LU orcid and Mohammad, Moman A. LU orcid (2025) In JACC: Cardiovascular Interventions 18(4). p.455-467
Abstract

Background: Long-term data on safety and efficacy of instantaneous wave-free ratio (IFR) vs fractional flow reserve (FFR) in guiding percutaneous coronary intervention (PCI) is lacking. Objectives: This study sought to evaluate the 5-year clinical outcomes of IFR- vs FFR-guided PCI in a real-world setting. Methods: We assessed the 5-year outcomes of all patients undergoing IFR or FFR assessment between January 1, 2014, and February 16, 2022, using data from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. Two-to-1 propensity score matching was used to adjust for differences between groups. Additional analyses adjusted for... (More)

Background: Long-term data on safety and efficacy of instantaneous wave-free ratio (IFR) vs fractional flow reserve (FFR) in guiding percutaneous coronary intervention (PCI) is lacking. Objectives: This study sought to evaluate the 5-year clinical outcomes of IFR- vs FFR-guided PCI in a real-world setting. Methods: We assessed the 5-year outcomes of all patients undergoing IFR or FFR assessment between January 1, 2014, and February 16, 2022, using data from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. Two-to-1 propensity score matching was used to adjust for differences between groups. Additional analyses adjusted for propensity score, PCI center, and baseline differences remaining after matching were conducted. The primary outcome was major adverse cardiac events (MACE) defined as first occurrence of all-cause death, myocardial infarction, or repeat revascularization within 5 years. Results: Among 16,152 (65.6%) of 24,623 FFR and 8,471 (34.4%) of 24,623 IFR patients, IFR led to more frequent deferral of revascularization (5,964 of 8,471 [70.4%] vs 10,615 of 24,623 [65.7%]; P < 0.001). There was no significant difference in Kaplan-Meier event rates in MACE at 5 years between patients who underwent IFR or FFR-guided revascularization (1,993 [31.3% (95% CI: 30.0%-32.6%)] vs 3,961 [31.9% (95% CI: 31.0%-32.8%)]; adjusted HR: 0.96; 95% CI: 0.82-1.12; P = 0.60), including all-cause death, cardiovascular death, cardiac death, coronary death, new myocardial infarction, or revascularization. Subgroup analysis of deferred and treated patients revealed no difference between groups regarding MACE or its individual components. Conclusions: In a large nationwide registry of patients undergoing physiology-based coronary revascularization, there were no significant differences in MACE or all-cause mortality between IFR and FFR-guided revascularization at 5 years.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
coronary physiology, FFR, IFR, SWEDEHEART
in
JACC: Cardiovascular Interventions
volume
18
issue
4
pages
13 pages
publisher
Elsevier
external identifiers
  • pmid:40010917
  • scopus:85217405098
ISSN
1936-8798
DOI
10.1016/j.jcin.2024.12.003
language
English
LU publication?
yes
id
96c65656-6592-403d-bb0c-b3f5e6441336
date added to LUP
2025-03-21 10:52:46
date last changed
2025-07-11 19:45:50
@article{96c65656-6592-403d-bb0c-b3f5e6441336,
  abstract     = {{<p>Background: Long-term data on safety and efficacy of instantaneous wave-free ratio (IFR) vs fractional flow reserve (FFR) in guiding percutaneous coronary intervention (PCI) is lacking. Objectives: This study sought to evaluate the 5-year clinical outcomes of IFR- vs FFR-guided PCI in a real-world setting. Methods: We assessed the 5-year outcomes of all patients undergoing IFR or FFR assessment between January 1, 2014, and February 16, 2022, using data from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. Two-to-1 propensity score matching was used to adjust for differences between groups. Additional analyses adjusted for propensity score, PCI center, and baseline differences remaining after matching were conducted. The primary outcome was major adverse cardiac events (MACE) defined as first occurrence of all-cause death, myocardial infarction, or repeat revascularization within 5 years. Results: Among 16,152 (65.6%) of 24,623 FFR and 8,471 (34.4%) of 24,623 IFR patients, IFR led to more frequent deferral of revascularization (5,964 of 8,471 [70.4%] vs 10,615 of 24,623 [65.7%]; P &lt; 0.001). There was no significant difference in Kaplan-Meier event rates in MACE at 5 years between patients who underwent IFR or FFR-guided revascularization (1,993 [31.3% (95% CI: 30.0%-32.6%)] vs 3,961 [31.9% (95% CI: 31.0%-32.8%)]; adjusted HR: 0.96; 95% CI: 0.82-1.12; P = 0.60), including all-cause death, cardiovascular death, cardiac death, coronary death, new myocardial infarction, or revascularization. Subgroup analysis of deferred and treated patients revealed no difference between groups regarding MACE or its individual components. Conclusions: In a large nationwide registry of patients undergoing physiology-based coronary revascularization, there were no significant differences in MACE or all-cause mortality between IFR and FFR-guided revascularization at 5 years.</p>}},
  author       = {{Götberg, Matthias and Berntorp, Karolina and Jeremias, Allen and Yndigegn, Troels and von Koch, Sacharias and Linder, Rickard and Koul, Sasha and Fröbert, Ole and Erlinge, David and Mohammad, Moman A.}},
  issn         = {{1936-8798}},
  keywords     = {{coronary physiology; FFR; IFR; SWEDEHEART}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{455--467}},
  publisher    = {{Elsevier}},
  series       = {{JACC: Cardiovascular Interventions}},
  title        = {{Long-Term Clinical Outcomes After IFR- vs FFR-Guided Coronary Revascularization : Insights From the SWEDEHEART National Registry}},
  url          = {{http://dx.doi.org/10.1016/j.jcin.2024.12.003}},
  doi          = {{10.1016/j.jcin.2024.12.003}},
  volume       = {{18}},
  year         = {{2025}},
}