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

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• dc.contributor.author Rodriguez-Leor, Oriol
• dc.contributor.author Millán, Raúl
• dc.contributor.author Pérez de Prado, Armando
• dc.date.accessioned 2023-01-27T07:28:35Z
• dc.date.available 2023-01-27T07:28:35Z
• dc.date.issued 2022
• dc.description.abstract Background: 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. Methods: 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. Results: 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). Conclusions: 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.
• dc.format.mimetype application/pdf
• dc.identifier.citation Rodriguez-Leor O, de la Torre Hernández JM, García-Camarero T, García Del Blanco B, López-Palop R, Fernández-Nofrerías E, et al. 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. Circ Cardiovasc Interv. 2022 Nov; 15(11):861-71. DOI: 10.1161/CIRCINTERVENTIONS.122.012328
• dc.identifier.doi http://dx.doi.org/10.1161/CIRCINTERVENTIONS.122.012328
• dc.identifier.issn 1941-7640
• dc.identifier.uri http://hdl.handle.net/10230/55446
• dc.language.iso eng
• dc.publisher Lippincott Williams & Wilkins
• dc.rights Copyright © 2022 Rodriguez-Leor O, de la Torre Hernández JM, García-Camarero T, García Del Blanco B, López-Palop R, Fernández-Nofrerías E, et al. Circulation: Cardiovascular Interventions is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.other Cateterisme
• dc.subject.other Cor -- Malalties
• dc.subject.other Angiografia
• dc.subject.other Ecografia
• dc.subject.other Prognosi
• dc.subject.other Estenosi
• dc.title 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
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion