Key result
Physiologically-guided revascularisation shows similar MACE rates compared to deferred revascularisation.
Why the study?
The study was conducted to assess the clinical outcomes of revascularisation based on FFR and/or iFR.
Does performing versus deferring revascularisation based on FFR/iFR affect MACE in patients with moderate to severe coronary stenosis?
Cohort
No
Does performing versus deferring revascularisation based on FFR/iFR affect MACE in patients with moderate to severe coronary stenosis?
Absolute Event Rate: 8.4% vs 6.4%
Revascularisation guided by invasive physiological assessment (FFR/iFR) is clinically safe, with no significant difference in MACE between deferred and performed groups.
May support deferring revascularisation without excess MACE; leaves open confirmation in randomized trials.
OBJECTIVE: To assess the clinical outcomes of revascularisation based on fractional flow reserve (FFR) and/or instantaneous wave-free ratio (iFR). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Medicine, The Aga Khan University Hospital, Karachi from January 2012 to January 2020. METHODOLOGY: A cohort of patients having moderate to severe coronary stenosis, undergoing coronary revascularisation based on invasive physiological assessment (FFR or iFR) were assessed. The participants were divided into the revascularisation-deferred group and the revascularization-performed group, based on the physiological results. Cox-proportional hazard model building was done, using a stepwise approach by assessing all plausible interactions and considering p-value ≤0.05 as statistically significant. RESULTS: The frequency of major adverse cardiac event (MACE) and target vessel revascularisation was 8.4% and 3.2% in the revascularisation-performed group as compared to 6.4% and 3.2% in the revascularisation-deferred group. In adjusted models, no statistically significant difference was noted in MACE when comparing the revascularisation-performed group with a deferred group. CONCLUSION: Revascularisation guided by invasive physiological assessment with FFR or iFR is clinically safe and led to better resource utilisation.
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Rahman et al. (2021) conducted a cohort in Moderate to severe coronary stenosis. Revascularisation performed vs. Revascularisation deferred was evaluated on Major adverse cardiac event (MACE). Physiologically-guided revascularisation resulted in similar rates of MACE compared to deferred revascularisation (8.4% vs 6.4%, with no statistically significant difference in adjusted models).
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