Key result
Deferral of percutaneous coronary intervention using a hybrid iFR-FFR strategy in patients with prior myocardial infarction provided a similar 1-year MACE rate compared to patients without prior myocardial infarction (HR 0.87).
Why the study?
The clinical usefulness of instantaneous wave-free ratio (iFR) for evaluating coronary artery lesions with prior myocardial infarction had not been evaluated.
Does instantaneous wave-free ratio (iFR) correlate with fractional flow reserve (FFR) for the evaluation of coronary artery lesions in patients with prior myocardial infarction?
Observational (n=200)
Yes
Does instantaneous wave-free ratio (iFR) correlate with fractional flow reserve (FFR) for the evaluation of coronary artery lesions in patients with prior myocardial infarction?
Effect estimate: HR 0.87 (95% CI 0.10-7.76)
Absolute Event Rate: 3.1% vs 3.5%
p-value: p=0.90
iFR correlates closely with FFR in coronary lesions with prior myocardial infarction, suggesting it is a valid vasodilator-free alternative for physiological assessment in this specific patient population.
May support deferral of PCI in prior MI using hybrid iFR-FFR; hypothesis-generating and requires randomized confirmation.
BACKGROUND: Fractional flow reserve (FFR) is useful for assessing the functional significance of coronary artery stenosis, even in lesions with prior myocardial infarction (pMI). Instantaneous wave-free ratio (iFR) is a vasodilator-free alternative for the physiological assessment of coronary artery stenosis. In addition, iFR shows good diagnostic agreement with FFR and an iFR-guided revascularization strategy was non-inferior to an FFR-guided revascularization strategy. However, the clinical usefulness of iFR for the evaluation of a coronary artery lesions with pMI has not been evaluated. METHODS AND RESULTS: A total of 200 lesions from 200 patients (44 pMI territories lesions and 156 non-pMI coronary artery lesions) were analyzed retrospectively. Major adverse cardiac events (MACE) were defined as cardiovascular death, non-fatal MI, unstable angina pectoris, fatal arrhythmia and heart failure during 12 months follow-up after the physiological assessment of coronary artery stenosis. iFR was closely correlated with FFR in pMI and non-pMI lesions (r = 0.81 and 0.72; P < 0.001, respectively). In pMI lesions, an iFR cut-off of 0.89 was optimal against a clinical FFR cut-off of 0.80 according to receiver operating characteristics (ROC) curve analysis, whereas in non-pMI lesions, the iFR cut-off value was 0.92 without statistical significance. In addition, the event rate of MACE was similar between pMI and non-pMI patients during follow-up even in the presence or absence of an PCI procedure. CONCLUSIONS: iFR may be a useful alternative method compared with FFR for clinical decision-making even in pMI patients.
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Fukuoka et al. (2019) conducted an observational in Stable coronary artery disease (n=200). Hybrid iFR-FFR guided deferral of PCI in prior myocardial infarction lesions vs. Hybrid iFR-FFR guided deferral of PCI in non-prior myocardial infarction lesions was evaluated on Major adverse cardiac events (MACE) at 1 year in deferred PCI patients (HR 0.87, 95% CI 0.10-7.76, p=0.90). Deferral of percutaneous coronary intervention using a hybrid iFR-FFR strategy in patients with prior myocardial infarction provided a similar 1-year MACE rate compared to patients without prior myocardial infarction (HR 0.87).
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