Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

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Escaned, JavierHosp Clin San Carlos, IDISSC, Madrid, Spain;Univ Complutense Madrid, Madrid, Spain,Hospital Clínico San Carlos, IDISSC, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain,Hammersmith Hospital, Imperial College London, London, United Kingdom,Imperial Coll London, UK,Imperial Coll London, Hammersmith Hosp, London, England,Complutense University of Madrid (author)

Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

Article/chapterEnglish2018

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Elsevier,2018
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LIBRIS-ID:oai:DiVA.org:lnu-77376
https://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-77376URI
https://doi.org/10.1016/j.jcin.2018.05.029DOI
https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-68506URI
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-363110URI
http://kipublications.ki.se/Default.aspx?queryparsed=id:138882033URI
https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-150483URI
https://lup.lub.lu.se/record/6992a4c3-76b3-484e-96b1-93e5a4e52e2aURI

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Language:English
Summary in:English

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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Funding Agencies:Philips Upsala Clinical Research Centre Volcano Imperial College Philips Volcano Imperial College London Medical Research Council
Funding Agencies|Philips; Upsala Clinical Research Centre; Volcano; Imperial College; Philips Volcano; Imperial College London; Medical Research Council
OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Omvårdnad hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Nursing hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
ACS
coronary physiology
deferral of revascularization
FFR
iFR
SAP
Omvårdnad
Nursing
ACS
coronary physiology
deferral of revascularization
FFR
iFR
SAP

Added entries (persons, corporate bodies, meetings, titles ...)

Ryan, NicolaHosp Clin San Carlos, IDISSC, Madrid, Spain;Univ Complutense Madrid, Madrid, Spain,Complutense University of Madrid (author)
Mejia-Renteria, HernanHosp Clin San Carlos, IDISSC, Madrid, Spain;Univ Complutense Madrid, Madrid, Spain,Complutense University of Madrid (author)
Cook, Christopher M.Imperial Coll London, UK,Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark,Amphia Hosp, Breda, Netherlands,Imperial Coll London, Hammersmith Hosp, London, England,Hammersmith Hospital (author)
Dehbi, Hakim-MoulayUCL, CRUK & UCL Canc Trials Ctr, London, England,University College London (author)
Alegria-Barrero, EduardoHosp Univ Torrejon, Madrid, Spain;Univ Francisco de Vitoria, Madrid, Spain,Imperial College London (author)
Alghamdi, AliKing Abdulaziz Med City Cardiac Ctr, Riyadh, Saudi Arabia,King Abdulaziz Medical City, Riyadh (author)
Al-Lamee, RashaImperial Coll London, UK,Imperial Coll London, Hammersmith Hosp, London, England,Hammersmith Hospital (author)
Altman, JohnColorado Heart & Vasc, Lakewood, CO USA,Colorado Heart and Vasc, CO USA (author)
Ambrosia, AlphonseMesa, Arizona, USA (author)
Baptista, Sergio B.Hosp Prof Doutor Fernando Fonseca, Amadora, Portugal (author)
Bertilsson, MariaUppsala universitet,Uppsala kliniska forskningscentrum (UCR),Uppsala Univ, Sweden,Uppsala University Hospital(Swepub:uu)marbe354 (author)
Bhindi, RavinayRoyal North Shore Hosp, Sydney, NSW, Australia,Royal North Shore Hospital (author)
Birgander, MatsLund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital(Swepub:lu)med-mbe (author)
Bojara, WaldemarKemperhof Koblenz, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany (author)
Brugaletta, SalvatoreInst Invest Biomed August Pi & Sunyer, Hosp Clin, Cardiovasc Inst, Barcelona, Spain,Inst Invest Biomed August Pi and Sunyer, Spain,Hospital Clínic of Barcelona (author)
Buller, ChristopherSt Michaels Hosp, Toronto, ON, Canada,Saint Michael's Hospital (author)
Calais, FredrikÖrebro University (author)
Silva, Pedro CanasHosp Santa Maria, Lisbon, Portugal,University of Lisbon (author)
Carlsson, JörgLinnaeus University,Linnéuniversitetet,Institutionen för hälso- och vårdvetenskap (HV),Kalmar County Hospital, Sweden,Linnaeus Univ, Fac Hlth & Life Sci, Kalmar, Sweden;Kalmar Cty Hosp, Kalmar, Sweden(Swepub:lnu)jocaaa (author)
Christiansen, Evald H.Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark,Aarhus University Hospital (author)
Danielewicz, MikaelKarlstad Hospital, Sweden,Karlstad Hosp, Dept Cardiol, Karlstad, Sweden (author)
Di Mario, CarloImperial Coll London, UK;Univ Florence, Italy,Univ Florence, Florence, Italy;Imperial Coll London, Royal Brompton Hosp, London, England,University of Florence (author)
Doh, Joon-HyungInje Univ, Republic of Korea,Inje Univ, Ilsan Paik Hosp, Daehwa Dong, South Korea (author)
Erglis, AndrejsPauls Stradins Clin Univ Hosp, Riga, Latvia,Riga Eastern Clinical University Hospital (author)
Erlinge, DavidLund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital(Swepub:lu)kard-der (author)
Gerber, Robert T.Conquest Hosp, St Leonards On Sea, England (author)
Going, OlafSana Klinikum Lichtenberg, Lichtenberg, Germany (author)
Gudmundsdottir, IngibjorgReykjavik Univ Hosp, Dept Cardiol, Reykjavik, Iceland,Reykjavik University (author)
Haerle, TobiasCarl von Ossietzky Univ Oldenburg, European Med Sch, Klinikum Oldenburg, Oldenburg, Germany (author)
Hauer, DarioLinköping University,Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US(Swepub:liu)n/a (author)
Hellig, FarrelSunninghill Hosp, Johannesburg, South Africa (author)
Indolfi, CiroMagna Graecia Univ Catanzaro, Catanzaro, Italy (author)
Jakobsen, LarsAarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark,Aarhus University Hospital (author)
Janssens, LucImelda Hosp, Bonheiden, Belgium (author)
Jensen, JensKarolinska Institutet,Karolinska Inst, Sweden; Capio St Gorans Sjukhus, Sweden; Sundsvall Hosp, Sweden,Flinders Univ S Australia, Australia,Acad Med Ctr, Netherlands,Antwerp Univ Hosp, Belgium,Sundsvall Hospital,Flinders University (author)
Jeremias, AllenSUNY Stony Brook, Med Ctr, Stony Brook, NY 11794 USA,Stony Brook University (author)
Karegren, AmraVästmanland Hospital Västerås, Sweden,Vastmanland Hosp Vasteras, Dept Internal Med, Vasteras, Sweden (author)
Karlsson, Ann-CharlotteHalmstad County Hospital, Sweden,Halmstad Cty Hosp, Dept Cardiol, Halmstad, Sweden (author)
Kharbanda, Rajesh K.Oxford Univ Hosp Fdn Trust, UK,Oxford Univ Hosp Fdn Trust, John Radcliffe Hosp, Oxford, England,University of Oxford (author)
Khashaba, AhmedAin Shams Univ, Cairo, Egypt,Ain Shams University (author)
Kikuta, YuetsuFukuyama Cardiovasc Hosp, Fukuyama, Hiroshima, Japan (author)
Krackhardt, FlorianUniv Med, Charite Campus Virchow Klinikum, Berlin, Germany,Charité - University Medicine Berlin (author)
Koo, Bon-KwonSeoul Natl Univ Hosp, Republic of Korea,Seoul Natl Univ Hosp, Seoul, South Korea,Seoul National University Hospital (author)
Koul, SashaLund University,Lunds universitet,Molekylär kardiologi,Forskargrupper vid Lunds universitet,Molecular Cardiology,Lund University Research Groups,Skåne University Hospital(Swepub:lu)med-sku (author)
Laine, MikaHelsinki Univ Hosp, Helsinki, Finland,Helsinki University Central Hospital (author)
Lehman, Sam J.Flinders Univ S Australia, Australia (author)
Lindroos, PontusSt Göran Hospital, Sweden,St Goran Hosp, Dept Cardiol, Stockholm, Sweden,Capio St. Görans Sjukhus (author)
Malik, Iqbal S.Imperial Coll London, UK,Imperial Coll London, Hammersmith Hosp, London, England (author)
Maeng, MichaelAarhus Univ Hosp, Denmark (author)
Matsuo, HitoshiGifu Heart Ctr, Gifu, Japan (author)
Meuwissen, MartijnAmphia Hosp, Netherlands (author)
Nam, Chang-WookKeimyung Univ, Republic of Korea,Keimyung Univ, Dongsan Med Ctr, Daegu, South Korea (author)
Niccoli, GiampaoloUniv Cattolica Sacro Cuore, Rome, Italy (author)
Nijjer, Sukhjinder S.Imperial Coll London, UK,Imperial Coll London, Hammersmith Hosp, London, England (author)
Olsson, HansKarlstad Hospital, Sweden,Karlstad Hosp, Dept Cardiol, Karlstad, Sweden (author)
Olsson, Sven ErikHelsingborg Hospital, Sweden,Helsingborg Hosp, Dept Cardiol, Helsingborg, Sweden;Helsingborg Hosp, Dept Radiol, Helsingborg, Sweden(Swepub:lu)kard-sol (author)
Omerovic, ElmirSahlgrensk, Sweden;University of Gothenburg, Sweden,Sahlgrenska Univ Gothenburg, Dept Cardiol, Gothenburg, Sweden (author)
Panayi, GeorgiosLinköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US(Swepub:liu)n/a (author)
Petraco, RicardoImperial Coll London, UK,Imperial Coll London, Hammersmith Hosp, London, England (author)
Piek, Jan J.Acad Med Ctr, Netherlands (author)
Ribichini, FlavoUniv Hosp Verona, Verona, Italy (author)
Samady, HabibEmory Univ, Atlanta, GA 30322 USA (author)
Samuels, BruceCedars Sinai Heart Inst, Los Angeles, CA USA (author)
Sandhall, LennartHelsingborg Hospital, Sweden,Helsingborg Hosp, Dept Cardiol, Helsingborg, Sweden;Helsingborg Hosp, Dept Radiol, Helsingborg, Sweden (author)
Sapontis, JamesMonashHeart, Melbourne, Vic, Australia;Monash Univ, Melbourne, Vic, Australia (author)
Sen, SayanImperial Coll London, UK,Royal Devon & Exeter Hosp, UK;Univ Exeter, UK,Univ Exeter, Exeter, Devon, England;Royal Devon & Exeter Hosp, Exeter, Devon, England,Royal Devon and Exeter Hosp, England; Univ Exeter, England (author)
Seto, Arnold H.Vet Affairs Long Beach Healthcare Syst, Long Beach, CA USA (author)
Sezer, MuratIstanbul Univ, Istanbul Fac Med, Istanbul, Turkey (author)
Sharp, Andrew S. P.Royal Devon & Exeter Hosp, UK;Univ Exeter, UK,Imperial Coll London, UK,Imperial Coll London, Dept Cardiol, London, England (author)
Shin, Eun-SeokUniv Ulsan, Republic of Korea,Univ Ulsan, Coll Med, Ulsan Univ Hosp, Ulsan, South Korea (author)
Singh, JasvindarWashington Univ, Sch Med, St Louis, MO USA (author)
Takashima, HiroakiAichi Med Univ Hosp, Nagakute, Aichi, Japan (author)
Talwar, SuneelRoyal Bournemouth Gen Hosp, UK,Royal Bournemouth Gen Hosp, Bournemouth, Dorset, England (author)
Tanaka, NobuhiroTokyo Med Univ, Tokyo, Japan (author)
Tang, KareEssex Cardiothorac Ctr, UK;Anglia Ruskin Univ, UK,Anglia Ruskin Univ, Chelmsford, England;Essex Cardiothorac Ctr, Basildon, England (author)
Van Belle, EricLille Univ Hosp, Inst Coeur Poumon, Lille, France;INSERM, Unite 1011, Lille, France (author)
van Royen, NielsVrije Univ Amsterdam Med Ctr, Amsterdam, Netherlands (author)
Varenhorst, Christoph,1977-Uppsala universitet,Kardiologi,Uppsala Univ, Sweden(Swepub:uu)chrva923 (author)
Vinhas, HugoHosp Garcia de Horta, Lisbon, Portugal (author)
Vrints, Christiaan J.Antwerp Univ Hosp, Belgium (author)
Walters, DarrenPrince Charles Hosp, Brisbane, Qld, Australia (author)
Yokoi, HiroyoshiFukuoka Sannou Hosp, Fukuoka, Japan (author)
Fröbert, Ole,1964-Örebro universitet,Institutionen för medicinska vetenskaper,Örebro University, Sweden,Orebro Univ, Fac Hlth, Dept Cardiol, Orebro, Sweden(Swepub:oru)oft (author)
Patel, Manesh R.Duke Univ, Durham, NC USA (author)
Serruys, PatrickImperial Coll London, UK (author)
Davies, Justin E.Imperial Coll London, UK (author)
Götberg, MatthiasLund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital(Swepub:lu)kard-mgo (author)
Hosp Clin San Carlos, IDISSC, Madrid, Spain;Univ Complutense Madrid, Madrid, SpainHospital Clínico San Carlos, IDISSC, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain (creator_code:org_t)

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By the author/editor: Escaned, Javier; Ryan, Nicola; Mejia-Renteria, ...; Cook, Christophe ...; Dehbi, Hakim-Mou ...; Alegria-Barrero, ...; show more...; Alghamdi, Ali; Al-Lamee, Rasha; Altman, John; Ambrosia, Alphon ...; Baptista, Sergio ...; Bertilsson, Mari ...; Bhindi, Ravinay; Birgander, Mats; Bojara, Waldemar; Brugaletta, Salv ...; Buller, Christop ...; Calais, Fredrik; Silva, Pedro Can ...; Carlsson, Jörg; Christiansen, Ev ...; Danielewicz, Mik ...; Di Mario, Carlo; Doh, Joon-Hyung; Erglis, Andrejs; Erlinge, David; Gerber, Robert T ...; Going, Olaf; Gudmundsdottir, ...; Haerle, Tobias; Hauer, Dario; Hellig, Farrel; Indolfi, Ciro; Jakobsen, Lars; Janssens, Luc; Jensen, Jens; Jeremias, Allen; Karegren, Amra; Karlsson, Ann-Ch ...; Kharbanda, Rajes ...; Khashaba, Ahmed; Kikuta, Yuetsu; Krackhardt, Flor ...; Koo, Bon-Kwon; Koul, Sasha; Laine, Mika; Lehman, Sam J.; Lindroos, Pontus; Malik, Iqbal S.; Maeng, Michael; Matsuo, Hitoshi; Meuwissen, Marti ...; Nam, Chang-Wook; Niccoli, Giampao ...; Nijjer, Sukhjind ...; Olsson, Hans; Olsson, Sven Eri ...; Omerovic, Elmir; Panayi, Georgios; Petraco, Ricardo; Piek, Jan J.; Ribichini, Flavo; Samady, Habib; Samuels, Bruce; Sandhall, Lennar ...; Sapontis, James; Sen, Sayan; Seto, Arnold H.; Sezer, Murat; Sharp, Andrew S. ...; Shin, Eun-Seok; Singh, Jasvindar; Takashima, Hiroa ...; Talwar, Suneel; Tanaka, Nobuhiro; Tang, Kare; Van Belle, Eric; van Royen, Niels; Varenhorst, Chri ...; Vinhas, Hugo; Vrints, Christia ...; Walters, Darren; Yokoi, Hiroyoshi; Fröbert, Ole, 19 ...; Patel, Manesh R.; Serruys, Patrick; Davies, Justin E ...; Götberg, Matthia ...; show less...

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