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Reclassification of...
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Andell, PontusLund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden,Lund Univ, Sweden
(author)
Reclassification of Treatment Strategy With Instantaneous Wave-Free Ratio and Fractional Flow Reserve : A Substudy From the iFR-SWEDEHEART Trial
- Article/chapterEnglish2018
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LIBRIS-ID:oai:lup.lub.lu.se:040f93e9-5e22-498b-96bf-3596e1d13748
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https://lup.lub.lu.se/record/040f93e9-5e22-498b-96bf-3596e1d13748URI
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https://doi.org/10.1016/j.jcin.2018.07.035DOI
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https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-69861URI
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https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-152375URI
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Language:English
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Summary in:English
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Subject category:art swepub-publicationtype
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Objectives: The authors sought to compare reclassification of treatment strategy following instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR). Background: iFR was noninferior to FFR in 2 large randomized controlled trials in guiding coronary revascularization. Reclassification of treatment strategy by FFR is well-studied, but similar reports on iFR are lacking. Methods: The iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome Trial) study randomized 2,037 participants with stable angina or acute coronary syndrome to treatment guided by iFR or FFR. Interventionalists entered the preferred treatment (optimal medical therapy [OMT], percutaneous coronary intervention [PCI], or coronary artery bypass grafting [CABG]) on the basis of coronary angiograms, and the final treatment decision was mandated by the iFR/FFR measurements. Results: In the iFR/FFR (n = 1,009/n = 1,004) populations, angiogram-based treatment approaches were similar (p = 0.50) with respect to OMT (38%/35%), PCI of 1 (37%/39%), 2 (15%/16%), and 3 vessels (2%/2%) and CABG (8%/8%). iFR and FFR reclassified 40% and 41% of patients, respectively (p = 0.78). The majority of reclassifications were conversion of PCI to OMT in both the iFR/FFR groups (31.4%/29.0%). Reclassification increased with increasing number of lesions evaluated (odds ratio per evaluated lesion for FFR: 1.46 [95% confidence interval: 1.22 to 1.76] vs. iFR 1.37 [95% confidence interval: 1.18 to 1.59]). Reclassification rates for patients with 1, 2, and 3 assessed vessels were 36%, 52%, and 53% (p < 0.01). Conclusions: Reclassification of treatment strategy of intermediate lesions was common and occurred in 40% of patients with iFR or FFR. The most frequent reclassification was conversion from PCI to OMT regardless of physiology modality. Irrespective of the physiological index reclassification of angiogram-based treatment strategy increased with the number of lesions evaluated.
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Berntorp, KarolinaLund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden,Lund Univ, Sweden(Swepub:lu)ka4470be
(author)
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Christiansen, Evald H.Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark,Aarhus Univ Hosp, Denmark
(author)
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Gudmundsdottir, Ingibjörg J.National University Hospital of Iceland,Department of Cardiology, University Hospital of Iceland, Reykjavik, Iceland,Univ Hosp Iceland, Iceland
(author)
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Sandhall, LennartDepartments of Cardiology and Radiology, Helsingborg Hospital, Helsingborg, Sweden,Helsingborg Hosp, Sweden
(author)
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Venetsanos, DimitriosLinköpings universitet,Linköping University,Departments of Cardiology and of Medical and Health Sciences, Linköping University, Linköping, Sweden,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US(Swepub:liu)dimve49
(author)
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Erlinge, DavidLund University,Lunds universitet,Molekylär kardiologi,Forskargrupper vid Lunds universitet,Molecular Cardiology,Lund University Research Groups,Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden,Lund Univ, Sweden(Swepub:lu)kard-der
(author)
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Fröbert, Ole,1964-Örebro universitet,Örebro University,Institutionen för medicinska vetenskaper,Department of Cardiology,Orebro Univ, Sweden(Swepub:oru)oft
(author)
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Koul, SashaLund University,Lunds universitet,Molekylär kardiologi,Forskargrupper vid Lunds universitet,Molecular Cardiology,Lund University Research Groups,Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden,Lund Univ, Sweden(Swepub:lu)med-sku
(author)
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Reitan, ChristianLund University,Lunds universitet,Arrhytmias and Cardiac Device treatment,Forskargrupper vid Lunds universitet,Lund University Research Groups,Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden,Lund Univ, Sweden(Swepub:lu)med-cr2
(author)
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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,Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden,Lund Univ, Sweden(Swepub:lu)kard-mgo
(author)
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KardiologiSektion II
(creator_code:org_t)
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In:JACC: Cardiovascular Interventions: Elsevier BV11:20, s. 2084-20941936-87981876-7605
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