Acute coronary syndrome guidelines recommend the use of iFR and FFR guided invasive management for patients with high risk ischemia regardless medical treatment. However, iFR and FFR they are often considered exchangeable.
Prior literature has shown there can be a discrepancy of around 20% between these techniques when it comes to revascularization outcomes. Choosing the adequate measurement has allowed better decision making and improved safety when deferring an intervention in relevant territories such as the left main. (DEFINE-LM registry).
The aim of this study was to look into the differences between iFR and FFR guided revascularization in patients with acute coronary syndrome and left main disease.
The DEFINE-LM registry data were looked at: the study included 275 patients with left main disease measured with iFR and FFR, 153 whose intervention was deferred and 122 undergoing revascularization. Primary end point was MACE prediction including MACE incidence and comparison between iFR and FFR guided revascularization outcomes through ROC curves.
Mean age was 66, 86% were men, syntax score was 21.4. Stenosis severity in deferred patients was 41.8% (average iFR 0.91 and FFR 0.82) and 49.5% in treated patients (iFR 0.85 and FFR 0.71).
Read also: EuroPCR 2023 | KISS: Provisional Stenting in Bifurcations.
Clinical outcomes at 35 months showed no statistically significant differences (HR 0.71, CI 95%0.38-1.92, P=0.28). There was a discrepancy between measurements in 21.1% of cases. Also, though there was MACE prediction when deferring with both measurements (iFR AUC: 0.74 and FFR AUC: 0.62) the iFR guided strategy was safer, while MACE in revascularization presented low predictability.
Dr. Omar Tupayachi.
Member of the Editorial Board of SOLACI.org.
Reference: Presented by Takayuki Warisawa en Late Breaking Trials Sessions, EuroPCR 2023, May 16, 2023, París, France.
Subscribe to our weekly newsletter
Get the latest scientific articles on interventional cardiology
