Key result
In all-comer patients undergoing coronary physiology assessment, the primary composite endpoint occurred in 6.1% overall at 18 months, with no significant difference between lesions revascularized based on iFR ≤ 0.89 (4.2%) and those deferred based on iFR > 0.89 (3.8%).
Why the study?
The study aimed to describe the experience and safety of coronary physiology assessment using iFR and Syncvision-guided iFR-pullback in all-comer patients in daily practice.
Cohort (n=277)
No
iFR-guided deferral shows comparable safety in all-comers; extends trial cutoffs to real-world use but leaves open randomized validation.
Introduction and objectives: The objective of this study was to describe our experience with coronary physiology assessment using the instantaneous wave-free ratio (iFR) and/or a Syncvision-guided iFR-pullback study [Syncvision version 4.1.0.5, Philips Volcano, Belgium] in all-comer patients. Methods: Consecutive patients undergoing coronary physiology assessment with the iFR (and/or a Syncvision-guided iFR-pullback study) at our center between January 2017 and December 2019 were included. The iFR cut-off value was 0.89. The primary endpoint was a composite of cardiac death, myocardial infarction, probable or definitive stent thrombosis, and target lesion revascularization. Results: A total of 277 patients with 433 lesions evaluated were included. The mean age was 65 ± 10 years and 74% were men. Personal history of diabetes mellitus was present in 41% of patients. Clinical presentation was stable angina in 160 patients (58%), and acute coronary syndrome in 117 patients (42%). iFRs > 0.89 were obtained in 266 lesions (61.4%) on which the PCI was postponed. The remaining lesions were revascularized. The Syncvision software was used to guide the iFR-pullback study in 155 lesions (36%) and the decision-making process, mainly in long, diffuse or sequential lesions (91 lesions, 58.7%), and intermediate lesions (52 lesions, 33.5%). After a median follow-up of 18 months, the primary endpoint occurred in 17 patients (6.1%) without differences regarding the baseline iFR (≤ 0.89 or > 0.89) (4.2% vs 3.8%; P = .9) or the clinical presentation (stable angina or acute coronary syndrome) (4.4% vs 8.5%; P = .1) Conclusions: The use of coronary physiology assessment with the iFR and the Syncvision-guided iFR-pullback study in the routine daily practice and in all-comer patients seems safe with a low percentage of major adverse cardiovascular events at the mid-term follow-up.
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Pericet-Rodríguez et al. (2021) conducted a cohort in Coronary artery disease (n=277). iFR ≤ 0.89 (revascularization) vs. iFR > 0.89 (deferred PCI) was evaluated on Composite of cardiac death, myocardial infarction, probable or definitive stent thrombosis, and target lesion revascularization (p=0.9). In all-comer patients undergoing coronary physiology assessment, the primary composite endpoint occurred in 6.1% overall at 18 months, with no significant difference between lesions revascularized based on iFR ≤ 0.89 (4.2%) and those deferred based on iFR > 0.89 (3.8%).
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