5-Year Outcomes of PCI Guided by Measurement of Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve

Matthias Götberg; Karolina Berntorp; Rebecca Rylance; Evald H. Christiansen; Troels Yndigegn; Ingibjörg J. Gudmundsdottir; Sasha Koul; Lennart Sandhall; Mikael Danielewicz; Lars Jakobsen; Sven Erik Olsson; Hans Olsson; Elmir Omerovic; Fredrik Calais; Pontus Lindroos; Michael Maeng; Dimitrios Venetsanos; Stefan K. James; Amra Kåregren; Jörg Carlsson; Jens Jensen; Ann Charlotte Karlsson; David Erlinge; Ole Fröbert

doi:10.1016/j.jacc.2021.12.030

5-Year Outcomes of PCI Guided by Measurement of Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve

Matthias Götberg^*, Karolina Berntorp, Rebecca Rylance, Evald H. Christiansen, Troels Yndigegn, Ingibjörg J. Gudmundsdottir, Sasha Koul, Lennart Sandhall, Mikael Danielewicz, Lars Jakobsen, Sven Erik Olsson, Hans Olsson, Elmir Omerovic, Fredrik Calais, Pontus Lindroos, Michael Maeng, Dimitrios Venetsanos, Stefan K. James, Amra Kåregren, Jörg CarlssonJens Jensen, Ann Charlotte Karlsson, David Erlinge, Ole Fröbert

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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Abstract

Background: Instantaneous wave-free ratio (iFR) is a coronary physiology index used to assess the severity of coronary artery stenosis to guide revascularization. iFR has previously demonstrated noninferior short-term outcome compared to fractional flow reserve (FFR), but data on longer-term outcome have been lacking. Objectives: The purpose of this study was to investigate the prespecified 5-year follow-up of the primary composite outcome of all-cause mortality, myocardial infarction, and unplanned revascularization of the iFR-SWEDEHEART trial comparing iFR vs FFR in 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. 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 (HR: 1.09; 95% 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 myocardial infarction (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 2 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, myocardial infarction, and unplanned revascularization compared with an FFR-guided revascularization strategy. (Evaluation of iFR vs FFR in Stable Angina or Acute Coronary Syndrome [iFR SWEDEHEART]; NCT02166736)

Original language	English
Journal	Journal of the American College of Cardiology
Volume	79
Issue	10
Pages (from-to)	965-974
Number of pages	10
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2021.12.030
Publication status	Published - Mar 2022

Keywords

coronary physiology
fractional flow reserve
instantaneous wave-free ratio
percutaneous coronary intervention

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10.1016/j.jacc.2021.12.030

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Götberg, M., Berntorp, K., Rylance, R., Christiansen, E. H., Yndigegn, T., Gudmundsdottir, I. J., Koul, S., Sandhall, L., Danielewicz, M., Jakobsen, L., Olsson, S. E., Olsson, H., Omerovic, E., Calais, F., Lindroos, P., Maeng, M., Venetsanos, D., James, S. K., Kåregren, A., ... Fröbert, O. (2022). 5-Year Outcomes of PCI Guided by Measurement of Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve. Journal of the American College of Cardiology, 79(10), 965-974. https://doi.org/10.1016/j.jacc.2021.12.030

@article{6cb30297dfab40fe90ba8aa551fa66cd,

title = "5-Year Outcomes of PCI Guided by Measurement of Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve",

abstract = "Background: Instantaneous wave-free ratio (iFR) is a coronary physiology index used to assess the severity of coronary artery stenosis to guide revascularization. iFR has previously demonstrated noninferior short-term outcome compared to fractional flow reserve (FFR), but data on longer-term outcome have been lacking. Objectives: The purpose of this study was to investigate the prespecified 5-year follow-up of the primary composite outcome of all-cause mortality, myocardial infarction, and unplanned revascularization of the iFR-SWEDEHEART trial comparing iFR vs FFR in 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. 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 (HR: 1.09; 95% 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 myocardial infarction (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 2 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, myocardial infarction, and unplanned revascularization compared with an FFR-guided revascularization strategy. (Evaluation of iFR vs FFR in Stable Angina or Acute Coronary Syndrome [iFR SWEDEHEART]; NCT02166736)",

keywords = "coronary physiology, fractional flow reserve, instantaneous wave-free ratio, percutaneous coronary intervention",

author = "Matthias G{\"o}tberg and Karolina Berntorp and Rebecca Rylance and Christiansen, {Evald H.} and Troels Yndigegn and Gudmundsdottir, {Ingibj{\"o}rg J.} and Sasha Koul and Lennart Sandhall and Mikael Danielewicz and Lars Jakobsen and Olsson, {Sven Erik} and Hans Olsson and Elmir Omerovic and Fredrik Calais and Pontus Lindroos and Michael Maeng and Dimitrios Venetsanos and James, {Stefan K.} and Amra K{\aa}regren and J{\"o}rg Carlsson and Jens Jensen and Karlsson, {Ann Charlotte} and David Erlinge and Ole Fr{\"o}bert",

note = "Publisher Copyright: {\textcopyright} 2022 American College of Cardiology Foundation",

year = "2022",

month = mar,

doi = "10.1016/j.jacc.2021.12.030",

language = "English",

volume = "79",

pages = "965--974",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier",

number = "10",

}

Götberg, M, Berntorp, K, Rylance, R, Christiansen, EH, Yndigegn, T, Gudmundsdottir, IJ, Koul, S, Sandhall, L, Danielewicz, M, Jakobsen, L, Olsson, SE, Olsson, H, Omerovic, E, Calais, F, Lindroos, P, Maeng, M, Venetsanos, D, James, SK, Kåregren, A, Carlsson, J, Jensen, J, Karlsson, AC, Erlinge, D & Fröbert, O 2022, '5-Year Outcomes of PCI Guided by Measurement of Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve', Journal of the American College of Cardiology, vol. 79, no. 10, pp. 965-974. https://doi.org/10.1016/j.jacc.2021.12.030

5-Year Outcomes of PCI Guided by Measurement of Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve. / Götberg, Matthias; Berntorp, Karolina; Rylance, Rebecca et al.
In: Journal of the American College of Cardiology, Vol. 79, No. 10, 03.2022, p. 965-974.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - 5-Year Outcomes of PCI Guided by Measurement of Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve

AU - Götberg, Matthias

AU - Berntorp, Karolina

AU - Rylance, Rebecca

AU - Christiansen, Evald H.

AU - Yndigegn, Troels

AU - Gudmundsdottir, Ingibjörg J.

AU - Koul, Sasha

AU - Sandhall, Lennart

AU - Danielewicz, Mikael

AU - Jakobsen, Lars

AU - Olsson, Sven Erik

AU - Olsson, Hans

AU - Omerovic, Elmir

AU - Calais, Fredrik

AU - Lindroos, Pontus

AU - Maeng, Michael

AU - Venetsanos, Dimitrios

AU - James, Stefan K.

AU - Kåregren, Amra

AU - Carlsson, Jörg

AU - Jensen, Jens

AU - Karlsson, Ann Charlotte

AU - Erlinge, David

AU - Fröbert, Ole

PY - 2022/3

Y1 - 2022/3

N2 - Background: Instantaneous wave-free ratio (iFR) is a coronary physiology index used to assess the severity of coronary artery stenosis to guide revascularization. iFR has previously demonstrated noninferior short-term outcome compared to fractional flow reserve (FFR), but data on longer-term outcome have been lacking. Objectives: The purpose of this study was to investigate the prespecified 5-year follow-up of the primary composite outcome of all-cause mortality, myocardial infarction, and unplanned revascularization of the iFR-SWEDEHEART trial comparing iFR vs FFR in 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. 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 (HR: 1.09; 95% 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 myocardial infarction (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 2 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, myocardial infarction, and unplanned revascularization compared with an FFR-guided revascularization strategy. (Evaluation of iFR vs FFR in Stable Angina or Acute Coronary Syndrome [iFR SWEDEHEART]; NCT02166736)

AB - Background: Instantaneous wave-free ratio (iFR) is a coronary physiology index used to assess the severity of coronary artery stenosis to guide revascularization. iFR has previously demonstrated noninferior short-term outcome compared to fractional flow reserve (FFR), but data on longer-term outcome have been lacking. Objectives: The purpose of this study was to investigate the prespecified 5-year follow-up of the primary composite outcome of all-cause mortality, myocardial infarction, and unplanned revascularization of the iFR-SWEDEHEART trial comparing iFR vs FFR in 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. 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 (HR: 1.09; 95% 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 myocardial infarction (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 2 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, myocardial infarction, and unplanned revascularization compared with an FFR-guided revascularization strategy. (Evaluation of iFR vs FFR in Stable Angina or Acute Coronary Syndrome [iFR SWEDEHEART]; NCT02166736)

KW - coronary physiology

KW - fractional flow reserve

KW - instantaneous wave-free ratio

KW - percutaneous coronary intervention

UR - http://www.scopus.com/inward/record.url?scp=85125465946&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2021.12.030

DO - 10.1016/j.jacc.2021.12.030

M3 - Journal article

C2 - 35272801

AN - SCOPUS:85125465946

SN - 0735-1097

VL - 79

SP - 965

EP - 974

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 10

ER -

5-Year Outcomes of PCI Guided by Measurement of Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve

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