Long-Term Clinical Outcomes After IFR- vs FFR-Guided Coronary Revascularization: Insights From the SWEDEHEART National Registry
- PMID: 40010917
- DOI: 10.1016/j.jcin.2024.12.003
Long-Term Clinical Outcomes After IFR- vs FFR-Guided Coronary Revascularization: Insights From the SWEDEHEART National Registry
Abstract
Background: Long-term data on safety and efficacy of instantaneous wave-free ratio (IFR) vs fractional flow reserve (FFR) in guiding percutaneous coronary intervention (PCI) is lacking.
Objectives: This study sought to evaluate the 5-year clinical outcomes of IFR- vs FFR-guided PCI in a real-world setting.
Methods: We assessed the 5-year outcomes of all patients undergoing IFR or FFR assessment between January 1, 2014, and February 16, 2022, using data from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. Two-to-1 propensity score matching was used to adjust for differences between groups. Additional analyses adjusted for propensity score, PCI center, and baseline differences remaining after matching were conducted. The primary outcome was major adverse cardiac events (MACE) defined as first occurrence of all-cause death, myocardial infarction, or repeat revascularization within 5 years.
Results: Among 16,152 (65.6%) of 24,623 FFR and 8,471 (34.4%) of 24,623 IFR patients, IFR led to more frequent deferral of revascularization (5,964 of 8,471 [70.4%] vs 10,615 of 24,623 [65.7%]; P < 0.001). There was no significant difference in Kaplan-Meier event rates in MACE at 5 years between patients who underwent IFR or FFR-guided revascularization (1,993 [31.3% (95% CI: 30.0%-32.6%)] vs 3,961 [31.9% (95% CI: 31.0%-32.8%)]; adjusted HR: 0.96; 95% CI: 0.82-1.12; P = 0.60), including all-cause death, cardiovascular death, cardiac death, coronary death, new myocardial infarction, or revascularization. Subgroup analysis of deferred and treated patients revealed no difference between groups regarding MACE or its individual components.
Conclusions: In a large nationwide registry of patients undergoing physiology-based coronary revascularization, there were no significant differences in MACE or all-cause mortality between IFR and FFR-guided revascularization at 5 years.
Keywords: FFR; IFR; SWEDEHEART; coronary physiology.
Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Funding Support and Author Disclosures This work was supported by the Swedish Heart and Lung Foundation (Drs Mohammad and Erlinge), Swedish Scientific Research Council (Dr Erlinge), Skåne University Hospital funds (Dr Erlinge and Mohammad), Thorsten Westerström’s foundation (Dr Mohammad), the ALF (Drs Mohammad and Erlinge), the Anna-Lisa and Sven-Eric Lundgren Foundation for Medical Research (Dr Mohammad), the Swedish Society of Medicine (Dr Mohammad), and the Crafoord Foundation (Dr Mohammad). The sponsors were not involved in the study design, collection of data, analysis of data, interpretation of data, writing of the manuscript, approving the manuscript, or the decision to submit manuscript for publication. The decision to submit manuscript was solely the authors. Dr Götberg is the European Principal Investigator for the DEFINE-GPS study; and has received minor consulting honoraria from Philips IGT in relation to study activities. Dr Jeremias has served as a consultant for Abbott Vascular, Philips/Volcano, ACIST Medical Systems, Shockwave, and CathWorks. Dr Erlinge has received speaker or advisory board honoraria from Bayer, AstraZeneca, Amgen, Novartis, Sanofi, and Chiesi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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