Revascularisation deferral (i.e. decision to treat medically) is a key aspect of physiology-based coronary revascularisation. In the post-ISCHEMIA trial scenario, it is key to understand whether decision-making with hyperaemic- and non-hyperaemic indices lead to similar rates of revascularization, and if this happens over the shifting age range of coronary patients. In a pooled patient analysis of the DEFINE FLAIR and iFR SWEDEHEART trials (n=4486), we investigated 1) the mid-term clinical outcomes associated to FFR- and iFR-based revascularization deferral, and 2) the relationship between patient age, revascularisation decision based on FFR or iFR, and clinical outcomes.
At 2-year follow up, the primary endpoint (MACE) rate in deferred patients (n=2130) was virtually identical in the iFR (7.43%) and FFR arm (7.40%) (0.03% difference), without significant differences in death, myocardial infarction and revascularization rates.
Overall (n= 4486), FFR lead to 5% more interventions than iFR. In patients <60 years (lower age quartile) this effect was more marked: FFR lead to 12% more revascularization procedures than iFR (deferral with iFR 54%; with FFR 42%; p<0.01). Of note, age influenced 2-year MACE in a remarkable manner only in patients with FFR-based deferral (FFR deferred HR 1.95 [95% CI 1.03, 3.70]; FFR treated HR 0.96 [0.67, 1.37]; p value for interaction 0.06). This interaction with age was not observed in patients deferred or treated based on iFR values.
In summary, our study 1) demonstrates similar safety of iFR and FFR in deferring revascularisation in the mid-term (2 year-follow up) and 2) reveals a strong interaction of age with FFR-based deferral, potentially related to a varying age-related hyperaemic response to adenosine, that merits further investigation.
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Notes to editors
Key information
o Presentation during the #PCR e-Course - http://www.pcr-ecourse.com
o Session on Main Arena Channel, Friday 26 June - 16:30:00 Paris time (UTC+2)
o PCR e-Course: 25, 26, 27 June 2020
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