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Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

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Author(s)
Javier EscanedNicola RyanHernán Mejía-RenteríaChristopher M. CookHakim-Moulay DehbiEduardo Alegria-BarreroAli AlghamdiRasha Al-LameeJohn AltmanAlphonse AmbrosiaSérgio B. BaptistaMaria BertilssonRavinay BhindiMats BirganderWaldemar BojaraSalvatore BrugalettaChristopher BullerFredrik CalaisPedro Canas SilvaJörg CarlssonEvald H. ChristiansenMikael DanielewiczCarlo Di MarioJoon-Hyung DohAndrejs ErglisDavid ErlingeRobert T. GerberOlaf GoingIngibjörg GudmundsdottirTobias HärleDario HauerFarrel HelligCiro IndolfiLars JakobsenLuc JanssensJens JensenAllen JeremiasAmra KåregrenAnn-Charlotte KarlssonRajesh K. KharbandaAhmed KhashabaYuetsu KikutaFlorian KrackhardtBon-Kwon KooSasha KoulMika LaineSam J. LehmanPontus LindroosS. MalikMichael MaengHitoshi MatsuoMartijn MeuwissenChang-Wook NamGiampaolo NiccoliSukhjinder S. NijjerHans OlssonSven-Erik OlssonElmir OmerovicGeorgios PanayiRicardo PetracoJan J. PiekFlavo RibichiniHabib SamadyBruce SamuelsLennart SandhallJames SapontisMurat SezerAndrew S.P. SharpEun-Seok ShinJasvindar SinghHiroaki TakashimaSuneel TalwarNobuhiro TanakaKare TangEric Van BelleNiels van RoyenChristoph VarenhorstHugo VinhasChristiaan J. VrintsDarren WaltersHiroyoshi YokoiOle FröbertManesh R. PatelPatrick SerruysJustin E. DaviesMatthias GötbergSayan SenArnold H. Seto
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
JACC: Cardiovascular Interventions
Issued Date
2018
Volume
11
Issue
15
Abstract
OBJECTIVES
The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS).

BACKGROUND
Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization.

METHODS
The safety of deferral of coronary revascularization in the pooled per-protocol population (n ¼ 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year.

RESULTS
Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p ¼ 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p ¼ 0.04).

CONCLUSIONS
Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. (J Am Coll Cardiol Intv 2018;11:1437–49) © 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Citation
Javier Escaned et al. (2018). Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes. JACC: Cardiovascular Interventions, 11(15), 1437–1449. doi: 10.1016/j.jcin.2018.05.029
Type
Article
ISSN
1876-7605
Source
https://www.sciencedirect.com/science/article/pii/S1936879818311439?via%3Dihub
DOI
10.1016/j.jcin.2018.05.029
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41755
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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