Instantaneous wave free ratio vs. fractional flow reserve and 5-year mortality: iFR SWEDEHEART and DEFINE FLAIR.

Autor:	Eftekhari A; Department Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark., Holck EN; Department Cardiology, Aarhus University Hospital, Denmark.; Department Clinical Medicine, Health, Aarhus University, Denmark., Westra J; Department Cardiology, Aarhus University Hospital, Denmark.; Department Cardiology, Linköping University Hospital, Sweden., Olsen NT; Department Cardiology, Gentofte University Hospital, Denmark., Bruun NH; Unit of Clinical Biostatistics, Aalborg University Hospital, Denmark., Jensen LO; Department Cardiology, Odense University Hospital, Denmark., Engstrøm T; Department Cardiology, Rigshospitalet Copenhagen, Denmark., Christiansen EH; Department Cardiology, Aarhus University Hospital, Denmark.; Department Clinical Medicine, Health, Aarhus University, Denmark.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2023 Nov 01; Vol. 44 (41), pp. 4376-4384.
DOI:	10.1093/eurheartj/ehad582
Abstrakt:	Background and Aims: Guidelines recommend revascularization of intermediate epicardial artery stenosis to be guided by evidence of ischaemia. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are equally recommended. Individual 5-year results of two major randomized trials comparing FFR with iFR-guided revascularization suggested increased all-cause mortality following iFR-guided revascularization. The aim of this study was a study-level meta-analysis of the 5-year outcome data in iFR-SWEDEHEART (NCT02166736) and DEFINE-FLAIR (NCT02053038). Methods: Composite of major adverse cardiovascular events (MACE) and its individual components [all-cause death, myocardial infarction (MI), and unplanned revascularisation] were analysed. Raw Kaplan-Meier estimates, numbers at risk, and number of events were extracted at 5-year follow-up and analysed using the ipdfc package (Stata version 18, StataCorp, College Station, TX, USA). Results: In total, iFR and FFR-guided revascularization was performed in 2254 and 2257 patients, respectively. Revascularization was more often deferred in the iFR group [n = 1128 (50.0%)] vs. the FFR group [n = 1021 (45.2%); P = .001]. In the iFR-guided group, the number of deaths, MACE, unplanned revascularization, and MI was 188 (8.3%), 484 (21.5%), 235 (10.4%), and 123 (5.5%) vs. 143 (6.3%), 420 (18.6%), 241 (10.7%), and 123 (5.4%) in the FFR group. Hazard ratio [95% confidence interval (CI)] estimates for MACE were 1.18 [1.04; 1.34], all-cause mortality 1.34 [1.08; 1.67], unplanned revascularization 0.99 [0.83; 1.19], and MI 1.02 [0.80; 1.32]. Conclusions: Five-year all-cause mortality and MACE rates were increased with revascularization guided by iFR compared to FFR. Rates of unplanned revascularization and MI were equal in the two groups. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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