The assessment of coronary stenosis using coronary physiology has become a key tool in guiding revascularization. The two most widely used techniques are fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), which is a non-hyperemic pressure ratio. While the non-inferiority of iFR compared to FFR has been demonstrated in the short term, there is limited evidence regarding its long-term performance in real-world settings.
The aim of the study presented by Götberg et al. was to assess the 5-year clinical outcomes of patients who underwent iFR-guided versus FFR-guided revascularization, using data from the Swedish national registry SWEDEHEART.
Researchers analyzed all patients who had undergone physiological assessment (FFR or iFR) between 2014 and 2022. To standardize the populations, propensity score matching was applied in a 2:1 ratio (FFR:iFR). The primary outcome was the occurrence of major adverse cardiovascular events (MACE) at 5 years, defined as all-cause death, acute myocardial infarction, or repeat revascularization.
A total of 24,623 patients were included (65.6% FFR; 34.4% iFR). The iFR group showed a higher rate of deferred treatment (70.4% vs. 65.7%, p <0.001). This group also had a higher proportion of women, smokers, and patients with diabetes.
At 5 years, there were no significant differences in the MACE rate (31.3% vs. 31.9%; adjusted hazard ratio [HR] 0.96, 95% confidence interval [CI]: 0.82–1.12; p=0.60), nor in its individual components: all-cause mortality, cardiovascular mortality, infarction, or repeat revascularization.
Read also: TAVR in Small Annuli: What Valve Should We Use?
There were no differences either between iFR and FFR when analyzing subgroups based on whether treatment was performed or deferred, and results remained consistent in multivariable and sensitivity analyses.
Conclusions
This analysis of a highly relevant registry such as SWEDEHEART found no significant differences in major cardiovascular events between iFR- and FFR-guided revascularization strategies. These findings support the clinical use of both as equivalent options in terms of long-term efficacy and safety.
Original Title: Long-Term Clinical Outcomes After IFR- vs FFR-Guided Coronary Revascularization Insights From the SWEDEHEART National Registry.
Reference: Götberg M, Berntorp K, Jeremias A, Yndigegn T, von Koch S, Linder R, Koul S, Fröbert O, Erlinge D, Mohammad MA. Long-Term Clinical Outcomes After IFR- vs FFR-Guided Coronary Revascularization: Insights From the SWEDEHEART National Registry. JACC Cardiovasc Interv. 2025 Feb 24;18(4):455-467. doi: 10.1016/j.jcin.2024.12.003. PMID: 40010917.