RT Journal Article
T1 Instantaneous Wave-Free Ratio for the Assessment of Intermediate Left Main Coronary Artery Stenosis: Correlations With Fractional Flow Reserve/Intravascular Ultrasound and Prognostic Implications: The iLITRO-EPIC07 Study.
A1 Rodriguez-Leor, Oriol
A1 de la Torre Hernández, José María
A1 García-Camarero, Tamara
A1 García Del Blanco, Bruno
A1 López-Palop, Ramón
A1 Fernández-Nofrerías, Eduard
A1 Cuellas Ramón, Carlos
A1 Jiménez-Kockar, Marcelo
A1 Jiménez-Mazuecos, Jesús
A1 Fernández Salinas, Francisco
A1 Gómez-Lara, Josep
A1 Brugaletta, Salvatore
A1 Alfonso, Fernando
A1 Palma, Ricardo
A1 Gómez-Menchero, Antonio E
A1 Millán, Raúl
A1 Tejada Ponce, David
A1 Linares Vicente, José Antonio
A1 Ojeda, Soledad
A1 Pinar, Eduardo
A1 Fernández-Pelegrina, Estefanía
A1 Morales-Ponce, Francisco J
A1 Cid-Álvarez, Ana Belén
A1 Rama-Merchan, Juan Carlos
A1 Molina Navarro, Eduardo
A1 Escaned, Javier
A1 Pérez de Prado, Armando
K1 coronary artery disease
K1 left main coronary artery disease
K1 ultrasound imaging
AB There is little information available on agreement between fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in left main coronary artery (LMCA) intermediate stenosis. Besides, several meta-analyses support the use of FFR to guide LMCA revascularization, but limited information is available on iFR in this setting. Our aims were to establish the concordance between FFR and iFR in intermediate LMCA lesions, to evaluate with intravascular ultrasound (IVUS) in cases of FFR/iFR discordance, and to prospectively validate the safety of deferring revascularization based on a hybrid decision-making strategy combining iFR and IVUS. Prospective, observational, multicenter registry with 300 consecutive patients with intermediate LMCA stenosis who underwent FFR and iFR and, in case of discordance, IVUS and minimal lumen area measurements. Primary clinical end point was a composite of cardiovascular death, LMCA lesion-related nonfatal myocardial infarction, or unplanned LMCA revascularization. FFR and iFR had an agreement of 80% (both positive in 67 and both negative in 167 patients); in case of disagreement (31 FFR+/iFR- and 29 FFR-/iFR+) minimal lumen area was ≥6 mm2 in 8.7% of patients with FFR+ and 14.6% with iFR+. Among the 300 patients, 105 (35%) underwent revascularization and 181 (60%) were deferred according to iFR and IVUS. At a median follow-up of 20 months, major adverse cardiac events incidence was 8.3% in the defer group and 13.3% in the revascularization group (hazard ratio, 0.71 [95% CI 0.30-1.72]; P=0.45). In patients with intermediate LMCA stenosis, a physiology-guided treatment decision is feasible either with FFR or iFR with moderate concordance between both indices. In case of disagreement, the use of IVUS may be useful to indicate revascularization. Deferral of revascularization based on iFR appears to be safe in terms of major adverse cardiac events. URL: https://www. gov; Unique identifier: NCT03767621.
YR 2022
FD 2022-09-16
LK http://hdl.handle.net/10668/20196
UL http://hdl.handle.net/10668/20196
LA en
DS RISalud
RD Apr 18, 2025