Key result
Evaluation of coronary lesions with instantaneous wave-free ratio resulted in higher deferral rates compared to fractional flow reserve, particularly in the right coronary artery (82.6% vs 69.8%), without increasing the risk of major adverse cardiac events at 5 years.
Why the study?
Cutoff values for deferral with FFR and iFR are uniform across coronary arteries despite differing coronary flow patterns, prompting comparison of vessel-specific deferral rates and outcomes.
Does iFR-guided deferral compared to FFR-guided deferral affect the rate of major adverse cardiac events in patients with coronary artery lesions?
Observational (n=33,241)
Yes
Does iFR-guided deferral compared to FFR-guided deferral affect the rate of major adverse cardiac events in patients with coronary artery lesions?
Hazard Ratio: 1.14 (95% CI 0.96–1.36)
Absolute Event Rate: 21.8% vs 24.6%
p-value: p=0.13
iFR-guided evaluation results in higher deferral rates compared to FFR across all coronary arteries, particularly in the RCA, without increasing the 5-year risk of major adverse cardiac events.
iFR may allow more safe deferrals than FFR in observational data; leaves open vessel-specific thresholds for randomized confirmation.
Background: Physiologically guided revascularization improves clinical outcomes. The cutoff values for deferral with fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are the same across all coronary arteries, despite differences in coronary flow patterns. The objective was to compare deferral rates using either FFR or iFR in the right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCx), and compare clinical outcomes in deferred lesions in the RCA, LAD, and LCx. Methods: Right coronary artery, LAD, and LCx lesions in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies registry that were evaluated using either FFR or iFR were included. The composite of major adverse cardiac events (MACE) within 5 years and the individual components of cardiovascular death, noncardiovascular death, myocardial infarction, target segment revascularization, and target vessel revascularization were analyzed. Results: = .007). No significant differences were observed in the MACE rate or its individual components at 5 years between the deferred FFR and iFR groups in any of the investigated vessels. Conclusions: Instantaneous wave-free ratio demonstrated a higher deferral rate across all coronary arteries than those examined with FFR, which was especially pronounced in the RCA, without any associated increased risk of MACE.
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Berntorp et al. (2025) conducted an observational in Coronary artery disease (n=33,241). Instantaneous wave-free ratio (iFR) vs. Fractional flow reserve (FFR) was evaluated on Major adverse cardiac events (MACE) at 5 years in deferred right coronary artery (RCA) lesions (HR 1.14, 95% CI 0.96-1.36, p=0.13). Evaluation of coronary lesions with instantaneous wave-free ratio resulted in higher deferral rates compared to fractional flow reserve, particularly in the right coronary artery (82.6% vs 69.8%), without increasing the risk of major adverse cardiac events at 5 years.
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