Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes
Why the study?
Does deferral of coronary revascularization based on iFR compared to FFR affect the rate of MACE at 1 year in patients with stable angina pectoris or acute coronary syndromes?
Population
4,486 patients from the pooled per-protocol population of the DEFINE-FLAIR and iFR-SWEDEHEART randomized…
Comparison
Deferral of coronary revascularization on the… vs Deferral of coronary revascularization on the…
Design
Meta-analysis
Follow-up
1 year
Authors
Discussion
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Member takes
Implication
Supports equivalent safety for iFR- or FFR-guided deferral at 1 year; confirms equivalence in a large meta-analysis.
Structured PICO
Does deferral of coronary revascularization based on iFR compared to FFR affect the rate of MACE at 1 year in patients with stable angina pectoris or acute coronary syndromes?
P
Population
4,486 patients from the pooled per-protocol population of the DEFINE-FLAIR and iFR-SWEDEHEART randomized clinical trials with stable angina pectoris (SAP) or acute coronary syndromes (ACS). 2,130 patients were deferred from coronary revascularization.
I
Intervention
Deferral of coronary revascularization on the basis of instantaneous wave-free ratio (iFR) measurement
C
Comparator
Deferral of coronary revascularization on the basis of fractional flow reserve (FFR) measurement
O
Outcome
Major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 yearcomposite
Deferral of coronary revascularization based on iFR is as safe as deferral based on FFR at 1 year, though deferred ACS patients have a higher event rate than deferred SAP patients.
Cite This Study
Escaned et al. (2018) studied this question.