Lecture by Dr. Hector García García – LM-PCI: IVUS and FFR/IFR? Dr. Hector García delivered an excellent presentation on whether we should use intravascular ultrasound (IVUS) or fractional flow reserve (FFR)/instantaneous wave-free ratio (iFR) in the left main coronary artery (LMCA) to consider severe obstruction, since there is significant interobserver variability with angiography. Although the...
Coronary physiology, FFR and iFR, has been shown safe to defer lesions and effective to save stents by different randomized studies and registries. However, patients with chronic kidney disease have not been thoroughly analyzed yet, which brings us to the question about what to do in the face of their negative evolution, when atherosclerosis develops...
To evaluate borderline coronary lesions (a 40% to 70% obstruction), determining associated ischemia is paramount. For this purpose, pressure gradients are measured across the stenosis. These measurements can be hyperemic, such as the fractional flow reserve (FFR), or taken at rest, such as the instantaneous wave-free ratio (iFR). According to the iFR-SWEDEHEART 5-year follow-up outcomes,...
Fractional flow reserve (FFR) proved to be very useful and safe in the FAME study, but its trade-off was using adenosine (which has a short half-life) and adverse reactions, which fortunately were rare. Subsequently, two large studies—the iFR-SWEDEHEART and DEFINE-FLAIR—demonstrated that instantaneous wave-free ratio (iFR) offered comparable results to FFR in the short term, avoiding...
Fractional flow reserve (FFR) has been shown effective and safe by different studies, yet not at 5 years. The aim of this multicenter registry was to assess the impact of thrombotic risk (as per CREDO-Kyoto score) as a predictor of cardiovascular events at 5 years in patients with deferred revascularization after FFR measurement. The score...
FLAVOUR was a prospective randomized non-inferiority study in patients with intermediate coronary lesions (40%-70%) that compared two imaging modalities: IVUS (intravascular imaging) and FFR (fractional flow reserve). According to this research—presented at ACC 2022—, FFR-guided angioplasty was non-inferior to IVUS-guided angioplasty at 2 years of follow-up. Furthermore, using FFR-based imaging led to fewer stent implantations....
This last year, new data in coronary disease gave way to changes in practices and new hypotheses, when not simply further justified the already existing evidence. In this new editorial section, we share the most relevant of last year’s works to keep you up to speed on the main topics in the field. The Most...
01- Management of Abdominal Aortic Aneurysms in 2021 Abdominal aortic aneurysms (AAA) are those of >3 cm aortic diameter. They run the risk of rupture and ensuing death by bleeding. In consequence, they are treated to repair the aneurysm before it ruptures. Read more HERE 02- Ten Commandments for 2021 Guidelines on Valvular Heart Disease Since...
Compared with visual estimation of lesions, using quantitative angiography-derived fractional flow reserve (quantitative flow ration, QFR) provides better clinical outcomes at one year for angioplasty. These results emerge from the Chinese FAVOR III study, presented at the 2021 TCT scientific sessions and simultaneously published in The Lancet. The simplicity and safety offered by QRF—since there is...
Angioplasty could not reach non-inferiority to surgery to treat patients with three-vessel lesions. In this head-to-head study of both revascularization strategies in patients with three-vessel coronary disease, fractional flow reserve (FFR)-guided angioplasty could not reach the performance of myocardial revascularization surgery in relation to a composite of adverse events. The FAME 3 study was presented during...