Two-year outcomes after revascularisation deferral based on FFR or iFR measurements

June 25, 2020

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% revascularization procedures than ifr (deferral with 54%; 42%; p<0.01). of note, influenced 2-year mace in a remarkable manner only patients ffr-based deferral (ffr deferred hr 1.95 [95% ci 1.03, 3.70]; treated 0.96 [0.67, 1.37]; p value for interaction 0.06). not observed or based on 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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