No decision on the coronary tree has more impact than left main intervention. This makes interventionists prone to over and underestimation of angiographic imaging. In other words, in real life we never report on angiograms showing moderate left main lesions. This reality should be looked into, since operating or intervening moderate left main lesions on…
FFR and iFR Discordance in up to 20% of Cases: Which One Should Inform Our Decisions?
Invasive functional measurement of intermediate lesions has become the gold standard to define revascularization. Due to its favorable long-term prognostic value, fractional flow reserve (FFR) is the reference used to compare all others. Recently, new nonhyperemic indexes, measured in a specific diastolic period, have emerged. Among them, the one with the most accumulated evidence is…
TCT 2020 | Fewer Symptoms and Events when Optimizing with iFR
Symptomatic patients undergoing PCI with no residual ischemia confirmed by iFR have superior symptom improvement at one year vs. patients who did not receive the optimization. In addition to symptoms, patients receiving iFR optimization (final value ≥ 0.95) presented lower cardiac mortality, spontaneous MI or clinically justified revascularization vs. patients with <0.95 final value. …
EuroPCR 2020 | Deferral Based on iFR vs. FFR: Are They Equivalent or Is There a New “Gold Standard”?
Age may impact results when making an angioplasty choice based on fractional flow reserve (FFR) vs. instantaneous wave-free ratio (iFR). After 2 years of follow-up, patients whose treatment of intermediate lesions was deferred based on functional testing had similar outcomes regardless of whether this decision was informed by FFR or iFR. However, iFR performance was constant,…
Is the Use of iFR for the Deferral of Left Main Coronary Artery Lesions Safe?
Deferral of left main coronary artery lesions using instantaneous wave-free ratio (iFR) seems to be safe. At the least, patients with deferred lesions had similar long-term prognosis to that of patients who underwent revascularization based on that same indicator. Left main coronary artery lesions were universally excluded from studies including medical treatment among the therapeutic…
Plaque Morphology Could Modify Functional Measurements
The vulnerable features of plaque are independently associated to functional measurements done under hyperemia far better than baseline measurements such as iFR. These findings suggest that not only stenosis severity but also plaque features contribute to functional measurements. This is a sub-study of the PACIFIC (Prospective Comparison of Cardiac PET/CT, SPECT/CT Perfusion Imaging and CT…
The Road Towards a “More Perfect” Angioplasty Is Already Being Traveled
The aim of revascularization, whether through angioplasty or surgery, is to restore adequate flow to the myocardium; that much is obvious. However, after millions of “successful” procedures with the best technology applied to drug-eluting stents and optimal medical treatment, we still have a high ratio of patients who experience new events. Could an optimal angiographical…
iFR or FFR Measurements by Sex: Is Either One More Adequate?
According to the post hoc analysis of the DEFINE-FLAIR, patient sex seems to affect instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) guided revascularization outcomes. Even though this is not specified in the study protocols, it might affect the gold standard for functional lesion assessment. However, clinical outcomes are similar with both strategies. Therefore,…
Discordance Between FFR and iFR. Which Measurement Is More Important?
In the next days, Dr. Seung Hun and colleagues will publish in J Am Coll Cardiol Intv 2019 a study that answers the title question and also brings peace of mind about the decisions we make based on one of these measurements or the other. This study assessed the physiologic characteristics of discordant lesions between…
Angiography-Derived FFR: Complicated Software or Imminent Reality?
Angiography-derived fractional flow reserve (FFR) demonstrated substantial usefulness, especially in patients with three-vessel lesions. The functional SYNTAX score derived from angiography has the potential to redefine prognosis and treatment strategies compared with the classic anatomical SYNTAX score. This study sought to investigate the applicability of this method in patients with multivessel lesions included in the…