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Long-term Safety of Revascularization Deferral Based on Instantaneous Wave-Free Ratio or Fractional Flow Reserve

Yndigegn, Troels LU ; Koul, Sasha LU ; Rylance, Rebecca LU ; Berntorp, Karolina LU orcid ; Mohammad, Moman A. LU ; Omerovic, Elmir ; Sarno, Giovanna ; Linder, Rickard ; Fröbert, Ole and Jensen, Jens , et al. (2023) In Journal of the Society for Cardiovascular Angiography and Interventions 2(5).
Abstract

Background: Deferral of coronary revascularization is safe whether guided by instantaneous wave-free ratio (iFR) or by fractional flow reserve (FFR). We aimed to assess long-term outcomes in patients deferred from revascularization based on iFR or FFR in a large real-world population. Methods: From 2013 through 2017, 201,933 coronary angiographies were registered in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). We included all patients (n = 11,324) with at least 1 coronary lesion deferred from PCI during an index procedure using iFR (>0.89; n = 1998) or FFR (>0.80; n = 9326). The primary outcome was major adverse cardiac... (More)

Background: Deferral of coronary revascularization is safe whether guided by instantaneous wave-free ratio (iFR) or by fractional flow reserve (FFR). We aimed to assess long-term outcomes in patients deferred from revascularization based on iFR or FFR in a large real-world population. Methods: From 2013 through 2017, 201,933 coronary angiographies were registered in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). We included all patients (n = 11,324) with at least 1 coronary lesion deferred from PCI during an index procedure using iFR (>0.89; n = 1998) or FFR (>0.80; n = 9326). The primary outcome was major adverse cardiac events (MACE) defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. A multivariable-adjusted Cox proportional hazards model was used, with analysis for interaction of prespecified subgroups. Results: Patients presented with stable angina pectoris (iFR 46.9% vs FFR 48.6%), unstable angina or non–ST-elevation myocardial infarction (iFR 37.7% vs FFR 33.1%), ST-elevation myocardial infarction (iFR 1.9% vs FFR 1.6%), and other indications (iFR 12.5% vs FFR 15.7%). The median follow-up was 2 years for both iFR and FFR groups. At the conclusion of the study, the cumulative MACE risks were 26.7 for the iFR group and 25.9% for FFR group. In the adjusted analysis, no difference was found between the 2 groups (adjusted hazard ratio: iFR vs FFR, 0.947; 95% CI, 0.84-1.08; P = 39). Consistent with the overall findings, the prespecified subgroups showed no interaction with the FFR/iFR results. Conclusions: Deferral of revascularization showed similar long-term safety whether based on iFR or on FFR.

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publication status
published
subject
keywords
coronary physiology, deferral of revascularization, fractional flow reserve, instantaneous wave-free ratio, SWEDEHEART
in
Journal of the Society for Cardiovascular Angiography and Interventions
volume
2
issue
5
article number
101046
publisher
Elsevier
external identifiers
  • scopus:85162851027
ISSN
2772-9303
DOI
10.1016/j.jscai.2023.101046
language
English
LU publication?
yes
id
c75b5c36-fafc-459d-9193-2ac1a238cb92
date added to LUP
2023-10-13 15:25:01
date last changed
2024-02-18 20:48:23
@article{c75b5c36-fafc-459d-9193-2ac1a238cb92,
  abstract     = {{<p>Background: Deferral of coronary revascularization is safe whether guided by instantaneous wave-free ratio (iFR) or by fractional flow reserve (FFR). We aimed to assess long-term outcomes in patients deferred from revascularization based on iFR or FFR in a large real-world population. Methods: From 2013 through 2017, 201,933 coronary angiographies were registered in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). We included all patients (n = 11,324) with at least 1 coronary lesion deferred from PCI during an index procedure using iFR (&gt;0.89; n = 1998) or FFR (&gt;0.80; n = 9326). The primary outcome was major adverse cardiac events (MACE) defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. A multivariable-adjusted Cox proportional hazards model was used, with analysis for interaction of prespecified subgroups. Results: Patients presented with stable angina pectoris (iFR 46.9% vs FFR 48.6%), unstable angina or non–ST-elevation myocardial infarction (iFR 37.7% vs FFR 33.1%), ST-elevation myocardial infarction (iFR 1.9% vs FFR 1.6%), and other indications (iFR 12.5% vs FFR 15.7%). The median follow-up was 2 years for both iFR and FFR groups. At the conclusion of the study, the cumulative MACE risks were 26.7 for the iFR group and 25.9% for FFR group. In the adjusted analysis, no difference was found between the 2 groups (adjusted hazard ratio: iFR vs FFR, 0.947; 95% CI, 0.84-1.08; P = 39). Consistent with the overall findings, the prespecified subgroups showed no interaction with the FFR/iFR results. Conclusions: Deferral of revascularization showed similar long-term safety whether based on iFR or on FFR.</p>}},
  author       = {{Yndigegn, Troels and Koul, Sasha and Rylance, Rebecca and Berntorp, Karolina and Mohammad, Moman A. and Omerovic, Elmir and Sarno, Giovanna and Linder, Rickard and Fröbert, Ole and Jensen, Jens and Schiopu, Alexandru and Erlinge, David and Götberg, Matthias}},
  issn         = {{2772-9303}},
  keywords     = {{coronary physiology; deferral of revascularization; fractional flow reserve; instantaneous wave-free ratio; SWEDEHEART}},
  language     = {{eng}},
  month        = {{09}},
  number       = {{5}},
  publisher    = {{Elsevier}},
  series       = {{Journal of the Society for Cardiovascular Angiography and Interventions}},
  title        = {{Long-term Safety of Revascularization Deferral Based on Instantaneous Wave-Free Ratio or Fractional Flow Reserve}},
  url          = {{http://dx.doi.org/10.1016/j.jscai.2023.101046}},
  doi          = {{10.1016/j.jscai.2023.101046}},
  volume       = {{2}},
  year         = {{2023}},
}