Instantaneous wave-free ratio as an alternative to fractional flow reserve in assessment of moderate coronary stenoses: A meta-analysis of diagnostic accuracy studies
| Autor: | Qusai Saleh, Rohan Samson, Camilo Fernandez, John C. Moscona, Anand Irimpen, Rohit Maini, Thierry H. LeJemtel, Paul Katigbak, Gursukhmandeep Sidhu |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Cardiac Catheterization medicine.medical_specialty Vasodilator Agents medicine.medical_treatment Hyperemia Diagnostic accuracy Coronary Artery Disease Fractional flow reserve 030204 cardiovascular system & hematology Revascularization Severity of Illness Index Likelihood ratios in diagnostic testing 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Internal medicine medicine Humans 030212 general & internal medicine Instantaneous wave-free ratio Aged business.industry Coronary Stenosis Reproducibility of Results General Medicine Middle Aged Prognosis Coronary Vessels Fractional Flow Reserve Myocardial Meta-analysis Diagnostic odds ratio Cardiology Female Outcome data Cardiology and Cardiovascular Medicine business |
| Zdroj: | Cardiovascular Revascularization Medicine. 19:613-620 |
| ISSN: | 1553-8389 |
| Popis: | Background/purpose Fractional flow reserve (FFR) remains underutilized due to practical concerns related to the need for hyperemic agents. These concerns have prompted the study of instantaneous wave-free ratio (iFR), a vasodilator-free index of coronary stenosis . Non-inferior cardiovascular outcomes have been demonstrated in two recent randomized clinic trials. We performed this meta-analysis to provide a necessary update of the diagnostic accuracy of iFR referenced to FFR based on the addition of eight more recent studies and 3727 more lesions. Methods We searched the PubMed, EMBASE, Central, ProQuest, and Web of Science databases for full text articles published through May 31, 2017 to identify studies addressing the diagnostic accuracy of iFR referenced to FFR ≤ 0.80. The following keywords were used: “instantaneous wave-free ratio” OR “iFR” AND “fractional flow reserve” OR “FFR.” Results In total, 16 studies comprising 5756 lesions were identified. Pooled diagnostic accuracy estimates of iFR versus FFR ≤ 0.80 were: sensitivity, 0.78 (95% CI, 0.76–0.79); specificity, 0.83 (0.81–0.84); positive likelihood ratio, 4.54 (3.85–5.35); negative likelihood ratio, 0.28 (0.24–0.32); diagnostic odds ratio, 17.38 (14.16–21.34); area under the summary receiver-operating characteristic curve, 0.87; and an overall diagnostic accuracy of 0.81 (0.78–0.84). Conclusions In conclusion, iFR showed excellent agreement with FFR as a resting index of coronary stenosis severity without the undesired effects and cost of hyperemic agents. When considering along with its clinical outcome data and ease of application, the diagnostic accuracy of iFR supports its use as a suitable alternative to FFR for physiology-guided revascularization of moderate coronary stenoses. Summary We performed a meta-analysis of the diagnostic accuracy of iFR referenced to FFR. iFR showed excellent agreement with FFR as a resting index of coronary stenosis severity without the undesired effects and cost of hyperemic agents. This supports its use as a suitable alternative to FFR for physiology-guided revascularization of moderate coronary stenoses. |
| Databáze: | OpenAIRE |
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