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Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes.

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Authors
Escaned, Javier
Ryan, Nicola
Mejía-Rentería, Hernán
Cook, Christopher M
Dehbi, Hakim-Moulay
Alegria-Barrero, Eduardo
Alghamdi, Ali
Al-Lamee, Rasha
Altman, John
Ambrosia, Alphonse
Baptista, Sérgio B
Bertilsson, Maria
Bhindi, Ravinay
Birgander, Mats
Bojara, Waldemar
Brugaletta, Salvatore
Buller, Christopher
Calais, Fredrik
Silva, Pedro Canas
Carlsson, Jörg
Christiansen, Evald H
Danielewicz, Mikael
Di Mario, Carlo
Doh, Joon-Hyung
Erglis, Andrejs
Erlinge, David
Gerber, Robert T
Going, Olaf
Gudmundsdottir, Ingibjörg
Härle, Tobias
Hauer, Dario
Hellig, Farrel
Indolfi, Ciro
Jakobsen, Lars
Janssens, Luc
Jensen, Jens
Jeremias, Allen
Kåregren, Amra
Karlsson, Ann-Charlotte
Kharbanda, Rajesh K
Khashaba, Ahmed
Kikuta, Yuetsu
Krackhardt, Florian
Koo, Bon-Kwon
Koul, Sasha
Laine, Mika
Lehman, Sam J
Lindroos, Pontus
Malik, Iqbal S
Maeng, Michael
Matsuo, Hitoshi
Meuwissen, Martijn
Nam, Chang-Wook
Niccoli, Giampaolo
Nijjer, Sukhjinder S
Olsson, Hans
Olsson, Sven-Erik
Omerovic, Elmir
Panayi, Georgios
Petraco, Ricardo
Piek, Jan J
Ribichini, Flavo
Samady, Habib
Samuels, Bruce
Sandhall, Lennart
Sapontis, James
Sen, Sayan
Seto, Arnold H
Sezer, Murat
Sharp, Andrew S P
Shin, Eun-Seok
Singh, Jasvindar
Takashima, Hiroaki
Talwar, Suneel
Tanaka, Nobuhiro
Tang, Kare
Van Belle, Eric
van Royen, Niels
Varenhorst, Christoph
Vinhas, Hugo
Vrints, Christiaan J
Walters, Darren
Yokoi, Hiroyoshi
Fröbert, Ole
Patel, Manesh R
Serruys, Patrick
Davies, Justin E
Götberg, Matthias
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Issue Date
2018-08-13

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Citation
JACC. Cardiovascular interventions 2018;11(15):1437-1449
Abstract
The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04).
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https://www.sciencedirect.com/science/article/pii/S1936879818311439
ae974a485f413a2113503eed53cd6c53
10.1016/j.jcin.2018.05.029
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