Instantaneous Wave-Free Ratio for the Assessment of Intermediate Left Main Coronary Artery Stenosis: Correlations With Fractional Flow Reserve/Intravascular Ultrasound and Prognostic Implications: The iLITRO-EPIC07 Study.

Autor:	Rodriguez-Leor O; Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (O.R.-L., E.F.-N.).; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain (O.R.-L., E.F.-N., A.B.C.-A.).; Institut de Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain (O.R.-L., E.F.-N.)., de la Torre Hernández JM; Cardiology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.M.d.l.T.H., T.G.-C.).; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain (J.M.d.l.T.H., T.G.-C.)., García-Camarero T; Cardiology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.M.d.l.T.H., T.G.-C.).; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain (J.M.d.l.T.H., T.G.-C.)., García Del Blanco B; Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (B.G.d.B., R.P.)., López-Palop R; Cardiology Department, Hospital Virgen de la Arrixaca, Murcia, Spain (R.L.-P., E.P.)., Fernández-Nofrerías E; Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (O.R.-L., E.F.-N.).; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain (O.R.-L., E.F.-N., A.B.C.-A.)., Cuellas Ramón C; Servicio de Cardiología, Hospital Universitario de León, Spain (C.C.R., A.P.d.P.)., Jiménez-Kockar M; Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (M.J.-K., E.F.-P.)., Jiménez-Mazuecos J; Servicio de Cardiología, Complejo Hospitalario Universitario de Albacete, Spain (J.J.-M.)., Fernández Salinas F; Cardiology Department, Hospital Universitari Joan XXIII, Tarragona, Spain (F.F.S.)., Gómez-Lara J; Cardiology Department, Hospital Universitari de Bellvitge, L'Hospital de Llobregat, Spain (J.G.-L.)., Brugaletta S; Cardiology Department, Hospital Clínic, Barcelona, Spain (S.B.).; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (S.B.).; University of Barcelona, Spain (S.B.)., Alfonso F; Cardiology Department, Hospital de la Princesa, Madrid, Spain (F.A.)., Palma R; Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (B.G.d.B., R.P.)., Gómez-Menchero AE; Cardiology Department, Hospital Universitario Juan Ramon Jiménez, Huelva, Spain (A.E.G.-M.)., Millán R; Cardiology Department, Hospital del Mar, Barcelona, Spain (R.M.)., Tejada Ponce D; Cardiology Department, Hospital General Universitario de Castellón, Castellón de la Plana, Spain (D.T.P.)., Linares Vicente JA; Cardiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain (J.A.L.V.)., Ojeda S; Division of Interventional Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain (S.O.)., Pinar E; Cardiology Department, Hospital Virgen de la Arrixaca, Murcia, Spain (R.L.-P., E.P.)., Fernández-Pelegrina E; Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (M.J.-K., E.F.-P.)., Morales-Ponce FJ; University of Cordoba, Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain (S.O.) Cardiology Department, Hospital Universitario de Puerto Real, Spain (F.J.M.-P.)., Cid-Álvarez AB; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain (O.R.-L., E.F.-N., A.B.C.-A.).; Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain (A.B.C.-A.)., Rama-Merchan JC; Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.C.R.-M.)., Molina Navarro E; Cardiology Department, Hospital de Mérida, Extremadura, Spain (E.M.N.)., Escaned J; Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain (J.E.).; Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdSSC), Madrid, Spain (J.E.).; Universidad Complutense de Madrid, Spain (J.E.)., Pérez de Prado A; Servicio de Cardiología, Hospital Universitario de León, Spain (C.C.R., A.P.d.P.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2022 Nov; Vol. 15 (11), pp. 861-871. Date of Electronic Publication: 2022 Sep 16.
DOI:	10.1161/CIRCINTERVENTIONS.122.012328
Abstrakt:	Background: There is little information available on agreement between fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in left main coronary artery (LMCA) intermediate stenosis. Besides, several meta-analyses support the use of FFR to guide LMCA revascularization, but limited information is available on iFR in this setting. Our aims were to establish the concordance between FFR and iFR in intermediate LMCA lesions, to evaluate with intravascular ultrasound (IVUS) in cases of FFR/iFR discordance, and to prospectively validate the safety of deferring revascularization based on a hybrid decision-making strategy combining iFR and IVUS. Methods: Prospective, observational, multicenter registry with 300 consecutive patients with intermediate LMCA stenosis who underwent FFR and iFR and, in case of discordance, IVUS and minimal lumen area measurements. Primary clinical end point was a composite of cardiovascular death, LMCA lesion-related nonfatal myocardial infarction, or unplanned LMCA revascularization. Results: FFR and iFR had an agreement of 80% (both positive in 67 and both negative in 167 patients); in case of disagreement (31 FFR+/iFR- and 29 FFR-/iFR+) minimal lumen area was ≥6 mm 2 in 8.7% of patients with FFR+ and 14.6% with iFR+. Among the 300 patients, 105 (35%) underwent revascularization and 181 (60%) were deferred according to iFR and IVUS. At a median follow-up of 20 months, major adverse cardiac events incidence was 8.3% in the defer group and 13.3% in the revascularization group (hazard ratio, 0.71 [95% CI 0.30-1.72]; P =0.45). Conclusions: In patients with intermediate LMCA stenosis, a physiology-guided treatment decision is feasible either with FFR or iFR with moderate concordance between both indices. In case of disagreement, the use of IVUS may be useful to indicate revascularization. Deferral of revascularization based on iFR appears to be safe in terms of major adverse cardiac events. Registration: URL: https://www. Clinicaltrials: gov; Unique identifier: NCT03767621.
Databáze:	MEDLINE
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