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Outcomes of PCI Guided by iFR vs. Fractional Flow Reserve
Quick Takes
- iFR-guided revascularization is known to be noninferior to FFR-guided strategy when comparing short-term clinical outcomes.
- The current study shows that among patients with chronic or acute coronary syndromes, there was no difference in 5-year clinical outcomes of death, MI, and unplanned revascularization between iFR-guided revascularization and FFR-guided approach.
Study Questions:
What are the long-term clinical outcomes comparing instantaneous wave free ratio (iFR)-guided and fractional flow reserve (FFR)-guided revascularization among patients with chronic and acute coronary syndromes?
Methods:
iFR-SWEDEHEART was a multicenter, controlled, open-label, registry-based randomized clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment. A total of 2,037 patients were randomized to undergo revascularization guided by iFR or FFR. This was a prespecified 5-year follow-up of the primary composite outcome of all-cause mortality, myocardial infarction (MI), and unplanned revascularization of the iFR-SWEDEHEART trial comparing iFR versus FFR in patients with chronic and acute coronary syndromes.
Results:
No patients were lost to follow-up. At 5 years, the rate of the primary composite endpoint was 21.5% in the iFR group and 19.9% in the FFR group (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.90-1.33). The rates of all-cause death (9.4% vs. 7.9%; HR, 1.20; 95% CI, 0.89-1.62), nonfatal MI (5.7% vs. 5.8%; HR, 1.00; 95% CI, 0.70-1.44), and unplanned revascularization (11.6% vs. 11.3%; HR, 1.02; 95% CI, 0.79-1.32) were also not different between the two groups. The outcomes were consistent across prespecified subgroups.
Conclusions:
In patients with chronic or acute coronary syndromes, an iFR-guided revascularization strategy was associated with no difference in the 5-year composite outcome of death, MI, and unplanned revascularization compared with an FFR-guided revascularization strategy.
Perspective:
The current study shows comparable outcomes between iFR- and FFR-guided revascularization after 5 years. Remarkably, there were no patients lost to follow-up and the current study shows that among patients with chronic or acute coronary syndromes, there was no difference in 5-year clinical outcomes of death, MI, and unplanned revascularization between iFR-guided revascularization and FFR-guided approach. These findings lend further support to the use of (simpler and quicker) iFR.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging
Keywords: Acute Coronary Syndrome, Angioplasty, Coronary Angiography, Coronary Artery Disease, Coronary Stenosis, Fractional Flow Reserve, Myocardial, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Outcome Assessment, Health Care, Percutaneous Coronary Intervention
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