Real-time use of instantaneous wave–free ratio: Results of the ADVISE in-practice: An international, multicenter evaluation of instantaneous wave–free ratio in clinical practice
Key result
Real-time measurement of instantaneous wave-free ratio (iFR) demonstrated high diagnostic agreement with fractional flow reserve, yielding an ROC AUC of 0.87 and an 80% classification match.
Why the study?
Does real-time instantaneous wave-free ratio (iFR) measurement provide comparable diagnostic agreement to fractional flow reserve (FFR) in evaluating angiographically intermediate coronary stenoses?
Population
392 angiographically intermediate coronary stenoses in a multicenter international analysis
Comparison
Real-time instantaneous wave-free ratio… vs Real-time fractional flow reserve measurement
Design
Cross-sectional
Authors
Discussion
Loading...
Member takes
Implication
Supports real-time iFR feasibility in intermediate stenoses; leaves open need for prospective outcome trials before hybrid strategies alter practice.
Key Points
- To evaluate the feasibility, diagnostic agreement, and reliability of real-time clinician measurement of the instantaneous wave-free ratio compared to fractional flow reserve.
- Multicenter international evaluation of 392 angiographically intermediate coronary stenoses.
- Clinicians performed instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) in real time using commercially available consoles.
- Calculated receiver operating characteristic area under the curve [ROC(AUC)] and diagnostic classification agreement across standard FFR cutoffs.
- For a clinical FFR cutoff of 0.80, real-time iFR achieved an ROC(AUC) of 0.87, an 80% classification match, and an optimal iFR cutoff of 0.90.
- For an ischemic FFR cutoff of 0.75, iFR yielded an ROC(AUC) of 0.90 with an 88% classification match (optimal cutoff 0.85); accounting for the 0.75 to 0.80 gray zone yielded an ROC(AUC) of 0.93 and 92% classification match.
- A hybrid iFR-FFR decision-making strategy spared 61% of the patient cohort from vasodilator administration while preserving a 94% overall classification agreement with FFR.
Study Design
Type
Observational (n=392)
Multicenter
Yes
Structured PICO
Does real-time instantaneous wave-free ratio (iFR) measurement provide comparable diagnostic agreement to fractional flow reserve (FFR) in evaluating angiographically intermediate coronary stenoses?
P
Population
392 angiographically intermediate coronary stenoses evaluated in a multicenter international analysis.
E
Exposure
Real-time instantaneous wave-free ratio (iFR) measurement on commercially available consoles
C
Comparator
Real-time fractional flow reserve (FFR) measurement
O
Outcome
Classification agreement of coronary stenoses between iFR and FFRsurrogate
Main Result
Effect estimate: ROC(AUC) 0.87
Real-time iFR measurement is feasible and maintains high diagnostic agreement with FFR, potentially sparing up to 61% of patients from vasodilator use when applied in a hybrid decision-making strategy.
Cite This Study
Petraco et al. (2014) conducted an observational in Angiographically intermediate coronary stenoses (n=392). Real-time instantaneous wave-free ratio (iFR) vs. Fractional flow reserve (FFR) was evaluated on Classification agreement of coronary stenoses between iFR and FFR (ROC(AUC) 0.87). Real-time measurement of instantaneous wave-free ratio (iFR) demonstrated high diagnostic agreement with fractional flow reserve, yielding an ROC AUC of 0.87 and an 80% classification match.