Safety of Lesion Deferral with iFR or FFR in Both Stable and Acute Patients

Overall, deferral of lesion revascularization is equally safe with both fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), with a low rate of events of about 4%. Lesions were more frequently deferred when iFR (as opposed to FFR) was used for functional assessment. Among patients with deferred lesions, acute patients experienced significantly more events than stable chronic patients.

Nuevo dispositivo para medición del FFR permite cruzar la lesión con nuestra guía preferidaThis study analyzed the safety of lesion deferral in the randomized populations (n = 4486) 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) trials.

 

Patients were stratified according to whether the revascularization decision was made on the basis of iFR or FFR and to clinical presentation (acute coronary syndrome and stable chronic disease).


Read also: Predictors of Conduction Disturbances Requiring a Late Permanent Pacemaker.


The primary endpoint was a composite of major adverse events (all-cause death, non-fatal infarction, and unplanned revascularization at one year).

 

Coronary revascularization was deferred in 2130 total patients: 1117 patients (50%) in the iFR group and 1013 patients (45%) in the FFR group (p < 0.01).


Read also: Ambulatory Continuous Monitoring in Patients with Left Bundle Branch Block After TAVI.


At 1 year, the rate of events in the population with deferred vessels was similar between the iFR and FFR groups (4.12% vs. 4.05%; p = 0.6). Among the deferred population, clinical presentation as acute coronary syndrome was associated with more events compared with chronic stable patients (5.91% vs. 3.64%; p = 0.04).

 

Conclusion

Deferral of revascularization is equally safe with both iFR and FFR, with a low event rate of around 4%. Lesions were more commonly deferred when iFR was used. After lesion deferral, patients with an acute coronary syndrome experienced more combined events than patients with stable chronic angina.

 

Original title: 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.

Reference: Javier Escaned et al. J Am Coll Cardiol Intv 2018; 11:1437-49.

 

2018-10-18-1437abierto.full


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....