iFR is a safe alternative for lesion deferral even when it comes to the left anterior descending artery (LAD). What is more, patients deferred with iFR showed significantly fewer events than patients deferred using FFR. Neither clinical cardiologists nor interventionists feel comfortable deferring LAD treatment, because it is often perceived as high risk. If functional…
iFR Assessment of Intermediate Aortic Stenosis Lesions Consolidates
Once a big void that prevented us from effectively assessing functional compromise, intermediate aortic stenosis has made us treat many lesions “just in case”, to save us what would be a complicated procedure, had a valve been placed. Auspiciously, some light has been shed by several, most welcome, studies simultaneously published in J Am Coll…
What Should We Use for the Functional Assessment of Coronary Lesions in Severe Aortic Stenosis?
This systematic analysis measured intracoronary pressure in different phases of the cardiac cycle and flow velocity in patients with severe aortic stenosis and coronary artery disease, who were scheduled for transcatheter aortic valve replacement (TAVR). The aim was to determine the impact of aortic stenosis on: 1) flow, at different phases; 2) hyperemic coronary flow;…
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…
Real-Life Functional Assessment of Coronary Stenosis: We Are Yet to Convert to It
The use of functional assessment of coronary stenosis (following the class IA recommendation in both American and European guidelines) is below 50% in daily clinical practice. Truth be told, most operators continue having blind faith in angiography. The inclusion of coronary physiology in the decision-making process has spread widely across countries, sites, and operators. The ERIS…
Angina Is as Subjective as Any Other Pain
Almost 80% of all patients randomized in this study reported Canadian Cardiovascular Society class II or III angina, and almost all of them (97%) had more than 1 positive non-invasive ischemia test that matched the area of their single diseased coronary vessel. Beyond fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR), the study randomized patients to…
EuroPCR 2018 | SYNTAX II: Results at 2 Years for Best Angioplasty vs. Surgery in Multivessel Disease
Since the publication of the original SYNTAX trial, there have been great technical advancements that have influenced the results of angioplasty: New tools for risk stratification using the SYNTAX II score which integrate clinical and anatomical variables to the team’s decision-making process. Functional revascularization (hybrid use of fractional flow reserve or instantaneous wave-free ratio). Optimization of…
ACC 2018 | DEFINE-FLAIR Sub-Analysis: iFR More Comfortable, Faster, and Much Cheaper
Using instantaneous wave-free ratio (iFR) to guide decisions on revascularization of intermediate lesions is cheaper than using fractional flow reserve (FFR). Based on costs from the DEFINE-FLAIR trial, researchers estimate the difference to be almost USD 1000. This should not be seen as good news for any given technology (iFR, in this case), but for physiologic…
Routine FFR/iFR Reclassifies Treatment Strategies in Half of Cases
Routine invasive physiology assessment at time of angiography reclassifies treatment strategies in a big number of patients with lesions in 2 or 3 vessels, according to the multicenter prospective study DEFINE REAL, recently published in JACC Cardiovascular Interventions. The information obtained by measuring fractional flow reserve (FFR) or instantaneous wave free ratio (iFR) made interventionists modify their original plans in…
The diagnostic performance of the iFR makes the FFR tremble
Despite the evidence, most stable patients continue to be managed based on coronary angiography and, worse, often without a prior non-invasive functional study. With the introduction of the FFR, we left the “anatomical” era for the “functional” era in the catheterization room, which has been proven to improve patients prognosis and, as if that were…