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Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI.
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- Christiansen, Evald H (författare)
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark,Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark.
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- Jensen, J. (författare)
- Karolinska Institute,Lund University,Lunds universitet,Karolinska Institutet,Reykjavik University Hospital, Iceland,Institutionen för translationell medicin,Medicinska fakulteten,Department of Translational Medicine,Faculty of Medicine,Karolinska Institute, Sweden; Capio St Gorans Sjukhus, Sweden; Sundsvall Hospital, Sweden,Karolinska Inst, Sodersjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden.;Capio St Gorans Sjukhus, Unit Cardiol, Stockholm, Sweden.;Sundsvall Hosp, Dept Med, Sundsvall, Sweden.,Kalmar County Hospital, Sweden; Linnaeus University, Sweden,Reykjavik Univ Hosp, Dept Cardiol, Reykjavik, Iceland.,Kalmar Cty Hosp, Dept Cardiol, Kalmar, Sweden.;Linnaeus Univ, Fac Hlth & Life Sci, Kalmar, Sweden.
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- Sandhall, Lennart (författare)
- Departments of Cardiology and Radiology, Helsingborg Hospital, Helsingborg, Sweden,Helsingborg Hosp, Dept Cardiol & Radiol, Helsingborg, Sweden.
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- Jensen, Jens (författare)
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- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark (creator_code:org_t)
- Massachussetts Medical Society, 2017
- 2017
- Engelska.
- Ingår i: The New England journal of medicine. - : Massachussetts Medical Society. - 1533-4406 .- 0028-4793. ; 376:19, s. 1813-1823
- Tidskriftsartikel (refereegranskat)
Abstract
Ämnesord
Stäng
- The instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking. We aimed to evaluate whether iFR is noninferior to FFR with respect to the rate of subsequent major adverse cardiac events.We conducted a multicenter, randomized, controlled, open-label clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment. A total of 2037 participants with stable angina or an acute coronary syndrome who had an indication for physiologically guided assessment of coronary-artery stenosis were randomly assigned to undergo revascularization guided by either iFR or FFR. The primary end point was the rate of a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization within 12 months after the procedure.A primary end-point event occurred in 68 of 1012 patients (6.7%) in the iFR group and in 61 of 1007 (6.1%) in the FFR group (difference in event rates, 0.7 percentage points; 95% confidence interval [CI], -1.5 to 2.8; P=0.007 for noninferiority; hazard ratio, 1.12; 95% CI, 0.79 to 1.58; P=0.53); the upper limit of the 95% confidence interval for the difference in event rates fell within the prespecified noninferiority margin of 3.2 percentage points. The results were similar among major subgroups. The rates of myocardial infarction, target-lesion revascularization, restenosis, and stent thrombosis did not differ significantly between the two groups. A significantly higher proportion of patients in the FFR group than in the iFR group reported chest discomfort during the procedure.Among patients with stable angina or an acute coronary syndrome, an iFR-guided revascularization strategy was noninferior to an FFR-guided revascularization strategy with respect to the rate of major adverse cardiac events at 12 months. (Funded by Philips Volcano; iFR SWEDEHEART ClinicalTrials.gov number, NCT02166736 .).
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- Acute Coronary Syndrome
- diagnostic imaging
- physiopathology
- Aged
- Angina Pectoris
- diagnostic imaging
- physiopathology
- Cardiovascular Diseases
- mortality
- Coronary Angiography
- Coronary Stenosis
- complications
- diagnostic imaging
- physiopathology
- therapy
- Female
- Follow-Up Studies
- Fractional Flow Reserve
- Myocardial
- Humans
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Myocardial Infarction
- epidemiology
- Percutaneous Coronary Intervention
- methods
- Retreatment
- Severity of Illness Index
- Cardiology
- Health and Caring Sciences
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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