Instantaneous wave free ratio vs. fractional flow reserve and 5-year mortality : iFR SWEDEHEART and DEFINE FLAIR
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com..
BACKGROUND AND AIMS: Guidelines recommend revascularization of intermediate epicardial artery stenosis to be guided by evidence of ischaemia. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are equally recommended. Individual 5-year results of two major randomized trials comparing FFR with iFR-guided revascularization suggested increased all-cause mortality following iFR-guided revascularization. The aim of this study was a study-level meta-analysis of the 5-year outcome data in iFR-SWEDEHEART (NCT02166736) and DEFINE-FLAIR (NCT02053038).
METHODS: Composite of major adverse cardiovascular events (MACE) and its individual components [all-cause death, myocardial infarction (MI), and unplanned revascularisation] were analysed. Raw Kaplan-Meier estimates, numbers at risk, and number of events were extracted at 5-year follow-up and analysed using the ipdfc package (Stata version 18, StataCorp, College Station, TX, USA).
RESULTS: In total, iFR and FFR-guided revascularization was performed in 2254 and 2257 patients, respectively. Revascularization was more often deferred in the iFR group [n = 1128 (50.0%)] vs. the FFR group [n = 1021 (45.2%); P = .001]. In the iFR-guided group, the number of deaths, MACE, unplanned revascularization, and MI was 188 (8.3%), 484 (21.5%), 235 (10.4%), and 123 (5.5%) vs. 143 (6.3%), 420 (18.6%), 241 (10.7%), and 123 (5.4%) in the FFR group. Hazard ratio [95% confidence interval (CI)] estimates for MACE were 1.18 [1.04; 1.34], all-cause mortality 1.34 [1.08; 1.67], unplanned revascularization 0.99 [0.83; 1.19], and MI 1.02 [0.80; 1.32].
CONCLUSIONS: Five-year all-cause mortality and MACE rates were increased with revascularization guided by iFR compared to FFR. Rates of unplanned revascularization and MI were equal in the two groups.
| Errataetall: |
CommentIn: Eur Heart J. 2023 Nov 1;44(41):4385-4387. - PMID 37634167 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:44 |
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| Enthalten in: |
European heart journal - 44(2023), 41 vom: 01. Nov., Seite 4376-4384 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Eftekhari, Ashkan [VerfasserIn] |
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| Links: |
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| Themen: |
Coronary physiology |
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| Anmerkungen: |
Date Completed 07.11.2023 Date Revised 09.11.2023 published: Print ClinicalTrials.gov: NCT02053038, NCT02166736 CommentIn: Eur Heart J. 2023 Nov 1;44(41):4385-4387. - PMID 37634167 Citation Status MEDLINE |
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| doi: |
10.1093/eurheartj/ehad582 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM361322658 |
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| 100 | 1 | |a Eftekhari, Ashkan |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Instantaneous wave free ratio vs. fractional flow reserve and 5-year mortality |b iFR SWEDEHEART and DEFINE FLAIR |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 07.11.2023 | ||
| 500 | |a Date Revised 09.11.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a ClinicalTrials.gov: NCT02053038, NCT02166736 | ||
| 500 | |a CommentIn: Eur Heart J. 2023 Nov 1;44(41):4385-4387. - PMID 37634167 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND AND AIMS: Guidelines recommend revascularization of intermediate epicardial artery stenosis to be guided by evidence of ischaemia. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are equally recommended. Individual 5-year results of two major randomized trials comparing FFR with iFR-guided revascularization suggested increased all-cause mortality following iFR-guided revascularization. The aim of this study was a study-level meta-analysis of the 5-year outcome data in iFR-SWEDEHEART (NCT02166736) and DEFINE-FLAIR (NCT02053038) | ||
| 520 | |a METHODS: Composite of major adverse cardiovascular events (MACE) and its individual components [all-cause death, myocardial infarction (MI), and unplanned revascularisation] were analysed. Raw Kaplan-Meier estimates, numbers at risk, and number of events were extracted at 5-year follow-up and analysed using the ipdfc package (Stata version 18, StataCorp, College Station, TX, USA) | ||
| 520 | |a RESULTS: In total, iFR and FFR-guided revascularization was performed in 2254 and 2257 patients, respectively. Revascularization was more often deferred in the iFR group [n = 1128 (50.0%)] vs. the FFR group [n = 1021 (45.2%); P = .001]. In the iFR-guided group, the number of deaths, MACE, unplanned revascularization, and MI was 188 (8.3%), 484 (21.5%), 235 (10.4%), and 123 (5.5%) vs. 143 (6.3%), 420 (18.6%), 241 (10.7%), and 123 (5.4%) in the FFR group. Hazard ratio [95% confidence interval (CI)] estimates for MACE were 1.18 [1.04; 1.34], all-cause mortality 1.34 [1.08; 1.67], unplanned revascularization 0.99 [0.83; 1.19], and MI 1.02 [0.80; 1.32] | ||
| 520 | |a CONCLUSIONS: Five-year all-cause mortality and MACE rates were increased with revascularization guided by iFR compared to FFR. Rates of unplanned revascularization and MI were equal in the two groups | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Coronary physiology | |
| 650 | 4 | |a Fractional flow reserve | |
| 650 | 4 | |a Instantaneous wave-free ratio | |
| 700 | 1 | |a Holck, Emil Nielsen |e verfasserin |4 aut | |
| 700 | 1 | |a Westra, Jelmer |e verfasserin |4 aut | |
| 700 | 1 | |a Olsen, Niels Thue |e verfasserin |4 aut | |
| 700 | 1 | |a Bruun, Niels Henrik |e verfasserin |4 aut | |
| 700 | 1 | |a Jensen, Lisette Okkels |e verfasserin |4 aut | |
| 700 | 1 | |a Engstrøm, Thomas |e verfasserin |4 aut | |
| 700 | 1 | |a Christiansen, Evald Høj |e verfasserin |4 aut | |
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