Long-term Safety of Revascularization Deferral Based on Instantaneous Wave-Free Ratio or Fractional Flow Reserve

Troels Yndigegn; Sasha Koul; Rebecca Rylance; Karolina Berntorp; Moman A. Mohammad; Elmir Omerovic; Giovanna Sarno; Rickard Linder; Ole Fröbert; Jens Jensen; Alexandru Schiopu; David Erlinge; Matthias Götberg

doi:10.1016/j.jscai.2023.101046

Long-term Safety of Revascularization Deferral Based on Instantaneous Wave-Free Ratio or Fractional Flow Reserve

Troels Yndigegn^*, Sasha Koul, Rebecca Rylance, Karolina Berntorp, Moman A. Mohammad, Elmir Omerovic, Giovanna Sarno, Rickard Linder, Ole Fröbert, Jens Jensen, Alexandru Schiopu, David Erlinge, Matthias Götberg

^*Corresponding author for this work

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

3 Citations (Scopus)

Abstract

Background: Deferral of coronary revascularization is safe whether guided by instantaneous wave-free ratio (iFR) or by fractional flow reserve (FFR). We aimed to assess long-term outcomes in patients deferred from revascularization based on iFR or FFR in a large real-world population. Methods: From 2013 through 2017, 201,933 coronary angiographies were registered in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). We included all patients (n = 11,324) with at least 1 coronary lesion deferred from PCI during an index procedure using iFR (>0.89; n = 1998) or FFR (>0.80; n = 9326). The primary outcome was major adverse cardiac events (MACE) defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. A multivariable-adjusted Cox proportional hazards model was used, with analysis for interaction of prespecified subgroups. Results: Patients presented with stable angina pectoris (iFR 46.9% vs FFR 48.6%), unstable angina or non–ST-elevation myocardial infarction (iFR 37.7% vs FFR 33.1%), ST-elevation myocardial infarction (iFR 1.9% vs FFR 1.6%), and other indications (iFR 12.5% vs FFR 15.7%). The median follow-up was 2 years for both iFR and FFR groups. At the conclusion of the study, the cumulative MACE risks were 26.7 for the iFR group and 25.9% for FFR group. In the adjusted analysis, no difference was found between the 2 groups (adjusted hazard ratio: iFR vs FFR, 0.947; 95% CI, 0.84-1.08; P = 39). Consistent with the overall findings, the prespecified subgroups showed no interaction with the FFR/iFR results. Conclusions: Deferral of revascularization showed similar long-term safety whether based on iFR or on FFR.

Original language	English
Article number	101046
Journal	Journal of the Society for Cardiovascular Angiography and Interventions
Volume	2
Issue	5
DOIs	https://doi.org/10.1016/j.jscai.2023.101046
Publication status	Published - 1 Sept 2023
Externally published	Yes

Keywords

coronary physiology
deferral of revascularization
fractional flow reserve
instantaneous wave-free ratio
SWEDEHEART

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10.1016/j.jscai.2023.101046Licence: CC BY-NC-ND

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Yndigegn, T., Koul, S., Rylance, R., Berntorp, K., Mohammad, M. A., Omerovic, E., Sarno, G., Linder, R., Fröbert, O., Jensen, J., Schiopu, A., Erlinge, D., & Götberg, M. (2023). Long-term Safety of Revascularization Deferral Based on Instantaneous Wave-Free Ratio or Fractional Flow Reserve. Journal of the Society for Cardiovascular Angiography and Interventions, 2(5), Article 101046. https://doi.org/10.1016/j.jscai.2023.101046

@article{1bcfdbde0d624610b2be09db7dac5531,

title = "Long-term Safety of Revascularization Deferral Based on Instantaneous Wave-Free Ratio or Fractional Flow Reserve",

abstract = "Background: Deferral of coronary revascularization is safe whether guided by instantaneous wave-free ratio (iFR) or by fractional flow reserve (FFR). We aimed to assess long-term outcomes in patients deferred from revascularization based on iFR or FFR in a large real-world population. Methods: From 2013 through 2017, 201,933 coronary angiographies were registered in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). We included all patients (n = 11,324) with at least 1 coronary lesion deferred from PCI during an index procedure using iFR (>0.89; n = 1998) or FFR (>0.80; n = 9326). The primary outcome was major adverse cardiac events (MACE) defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. A multivariable-adjusted Cox proportional hazards model was used, with analysis for interaction of prespecified subgroups. Results: Patients presented with stable angina pectoris (iFR 46.9% vs FFR 48.6%), unstable angina or non–ST-elevation myocardial infarction (iFR 37.7% vs FFR 33.1%), ST-elevation myocardial infarction (iFR 1.9% vs FFR 1.6%), and other indications (iFR 12.5% vs FFR 15.7%). The median follow-up was 2 years for both iFR and FFR groups. At the conclusion of the study, the cumulative MACE risks were 26.7 for the iFR group and 25.9% for FFR group. In the adjusted analysis, no difference was found between the 2 groups (adjusted hazard ratio: iFR vs FFR, 0.947; 95% CI, 0.84-1.08; P = 39). Consistent with the overall findings, the prespecified subgroups showed no interaction with the FFR/iFR results. Conclusions: Deferral of revascularization showed similar long-term safety whether based on iFR or on FFR.",

keywords = "coronary physiology, deferral of revascularization, fractional flow reserve, instantaneous wave-free ratio, SWEDEHEART",

author = "Troels Yndigegn and Sasha Koul and Rebecca Rylance and Karolina Berntorp and Mohammad, {Moman A.} and Elmir Omerovic and Giovanna Sarno and Rickard Linder and Ole Fr{\"o}bert and Jens Jensen and Alexandru Schiopu and David Erlinge and Matthias G{\"o}tberg",

note = "Publisher Copyright: {\textcopyright} 2023",

year = "2023",

month = sep,

day = "1",

doi = "10.1016/j.jscai.2023.101046",

language = "English",

volume = "2",

journal = "Journal of the Society for Cardiovascular Angiography and Interventions",

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Yndigegn, T, Koul, S, Rylance, R, Berntorp, K, Mohammad, MA, Omerovic, E, Sarno, G, Linder, R, Fröbert, O, Jensen, J, Schiopu, A, Erlinge, D & Götberg, M 2023, 'Long-term Safety of Revascularization Deferral Based on Instantaneous Wave-Free Ratio or Fractional Flow Reserve', Journal of the Society for Cardiovascular Angiography and Interventions, vol. 2, no. 5, 101046. https://doi.org/10.1016/j.jscai.2023.101046

Long-term Safety of Revascularization Deferral Based on Instantaneous Wave-Free Ratio or Fractional Flow Reserve. / Yndigegn, Troels; Koul, Sasha; Rylance, Rebecca et al.
In: Journal of the Society for Cardiovascular Angiography and Interventions, Vol. 2, No. 5, 101046, 01.09.2023.

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

TY - JOUR

T1 - Long-term Safety of Revascularization Deferral Based on Instantaneous Wave-Free Ratio or Fractional Flow Reserve

AU - Yndigegn, Troels

AU - Koul, Sasha

AU - Rylance, Rebecca

AU - Berntorp, Karolina

AU - Mohammad, Moman A.

AU - Omerovic, Elmir

AU - Sarno, Giovanna

AU - Linder, Rickard

AU - Fröbert, Ole

AU - Jensen, Jens

AU - Schiopu, Alexandru

AU - Erlinge, David

AU - Götberg, Matthias

PY - 2023/9/1

Y1 - 2023/9/1

N2 - Background: Deferral of coronary revascularization is safe whether guided by instantaneous wave-free ratio (iFR) or by fractional flow reserve (FFR). We aimed to assess long-term outcomes in patients deferred from revascularization based on iFR or FFR in a large real-world population. Methods: From 2013 through 2017, 201,933 coronary angiographies were registered in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). We included all patients (n = 11,324) with at least 1 coronary lesion deferred from PCI during an index procedure using iFR (>0.89; n = 1998) or FFR (>0.80; n = 9326). The primary outcome was major adverse cardiac events (MACE) defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. A multivariable-adjusted Cox proportional hazards model was used, with analysis for interaction of prespecified subgroups. Results: Patients presented with stable angina pectoris (iFR 46.9% vs FFR 48.6%), unstable angina or non–ST-elevation myocardial infarction (iFR 37.7% vs FFR 33.1%), ST-elevation myocardial infarction (iFR 1.9% vs FFR 1.6%), and other indications (iFR 12.5% vs FFR 15.7%). The median follow-up was 2 years for both iFR and FFR groups. At the conclusion of the study, the cumulative MACE risks were 26.7 for the iFR group and 25.9% for FFR group. In the adjusted analysis, no difference was found between the 2 groups (adjusted hazard ratio: iFR vs FFR, 0.947; 95% CI, 0.84-1.08; P = 39). Consistent with the overall findings, the prespecified subgroups showed no interaction with the FFR/iFR results. Conclusions: Deferral of revascularization showed similar long-term safety whether based on iFR or on FFR.

AB - Background: Deferral of coronary revascularization is safe whether guided by instantaneous wave-free ratio (iFR) or by fractional flow reserve (FFR). We aimed to assess long-term outcomes in patients deferred from revascularization based on iFR or FFR in a large real-world population. Methods: From 2013 through 2017, 201,933 coronary angiographies were registered in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). We included all patients (n = 11,324) with at least 1 coronary lesion deferred from PCI during an index procedure using iFR (>0.89; n = 1998) or FFR (>0.80; n = 9326). The primary outcome was major adverse cardiac events (MACE) defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. A multivariable-adjusted Cox proportional hazards model was used, with analysis for interaction of prespecified subgroups. Results: Patients presented with stable angina pectoris (iFR 46.9% vs FFR 48.6%), unstable angina or non–ST-elevation myocardial infarction (iFR 37.7% vs FFR 33.1%), ST-elevation myocardial infarction (iFR 1.9% vs FFR 1.6%), and other indications (iFR 12.5% vs FFR 15.7%). The median follow-up was 2 years for both iFR and FFR groups. At the conclusion of the study, the cumulative MACE risks were 26.7 for the iFR group and 25.9% for FFR group. In the adjusted analysis, no difference was found between the 2 groups (adjusted hazard ratio: iFR vs FFR, 0.947; 95% CI, 0.84-1.08; P = 39). Consistent with the overall findings, the prespecified subgroups showed no interaction with the FFR/iFR results. Conclusions: Deferral of revascularization showed similar long-term safety whether based on iFR or on FFR.

KW - coronary physiology

KW - deferral of revascularization

KW - fractional flow reserve

KW - instantaneous wave-free ratio

KW - SWEDEHEART

U2 - 10.1016/j.jscai.2023.101046

DO - 10.1016/j.jscai.2023.101046

M3 - Journal article

C2 - 39132394

AN - SCOPUS:85162851027

SN - 2772-9303

VL - 2

JO - Journal of the Society for Cardiovascular Angiography and Interventions

JF - Journal of the Society for Cardiovascular Angiography and Interventions

IS - 5

M1 - 101046

ER -

Long-term Safety of Revascularization Deferral Based on Instantaneous Wave-Free Ratio or Fractional Flow Reserve

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