Revascularization Deferral Safe Using Both iFR, FFR Measurements

The deferral of revascularization using instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements was equally safe, a new analysis suggested. 

Researchers for the new JACC: Cardiovascular Interventions study looked at the safety and deferral of coronary revascularization in a pooled per-protocol population of 4,486 patients from the DEFINE-FLAIR and SWEDEHEART trials. The patients were stratified by revascularization decision-making based on iFR or FFR measurements in stable angina pectoris and acute coronary syndromes at clinical presentation. The primary study endpoint was major adverse cardiac events (MACE; comprised of all-cause death, non-fatal myocardial infarction, or unplanned revascularization at one year).  

According to the analysis results, 2,130 patients deferred coronary revascularization (1,117 in the iFR group and 1,013 in the FFR group). The one-year MACE rate was similar between both groups (4.12% for iFR vs. 4.05% for FFR; HR=1.13; 95% CI, 0.72 to 1.79; P=0.60). Additionally, MACE rates were higher in patients presenting with acute coronary syndromes compared to those presenting with stable angina pectoris.  

“Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about four percent,” the researchers wrote. “Lesions were more frequently deferred when iFR was used to assess physiological significance.” 

Source: JACC Cardiovascular Interventions