Revascularization Deferral Safe Using Both iFR, FFR Measurements

The deferral of revascularization using instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements was equally safe, a new analysis suggested. 

Researchers for the new JACC: Cardiovascular Interventions study looked at the safety and deferral of coronary revascularization in a pooled per-protocol population of 4,486 patients from the DEFINE-FLAIR and SWEDEHEART trials. The patients were stratified by revascularization decision-making based on iFR or FFR measurements in stable angina pectoris and acute coronary syndromes at clinical presentation. The primary study endpoint was major adverse cardiac events (MACE; comprised of all-cause death, non-fatal myocardial infarction, or unplanned revascularization at one year).  

Deferring revascularization is equally safe w/ both iFR & FFR. However, does risk differ according to clinical presentation? https://t.co/3Bc8K9lXer #JACCINT pic.twitter.com/yRxgUUGcSX

— JACC Journals (@JACCJournals) August 9, 2018

According to the analysis results, 2,130 patients deferred coronary revascularization (1,117 in the iFR group and 1,013 in the FFR group). The one-year MACE rate was similar between both groups (4.12% for iFR vs. 4.05% for FFR; HR=1.13; 95% CI, 0.72 to 1.79; P=0.60). Additionally, MACE rates were higher in patients presenting with acute coronary syndromes compared to those presenting with stable angina pectoris.  

“Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about four percent,” the researchers wrote. “Lesions were more frequently deferred when iFR was used to assess physiological significance.” 

Deferral of revascularization fue to FFR or iFR in those presenting with ACS had a higher 1-year MACE rate than those presenting with SAP (5.91% vs. 3.64%; fully adjusted HR: 0.61; 95% CI: 0.38 to 0.99; p 1⁄4 0.04) https://t.co/z4kFjaNQpj pic.twitter.com/sL327RfxOe

— Juan Pablo Costabel MD 🇦🇷 (@jpcostabel) August 7, 2018

Deferring bystander lesions in ACS patients using a pressure wire is not as safe as deferring lesions in stable disease. Possible signal that hyperaemic indices are more vulnerable to this than resting indices. Microvascular dysfunction at play?https://t.co/02UkffXI8R

— Andrew SP Sharp (@drandrewsharp) August 9, 2018

we are doing more and more of this…. https://t.co/kq9pgrBz3g

— Prof Derek Connolly (@DrDerekConnolly) August 14, 2018

How safe is it to defer revascularization using both iFR and FFR? Combined analysis of DEFINE-FLAIR and iFR-SWEDEHEART indicates that deferral is equally safe with MACE rates of ~4% at 1-year. Learn more in #JACCINT: https://t.co/KBSviD7nFY. pic.twitter.com/OqjVNwP4Wg

— JACC Journals (@JACCJournals) August 14, 2018

Source: JACC Cardiovascular Interventions