Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI.

2.50
Hdl Handle:
http://hdl.handle.net/11287/620317
Title:
Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI.
Authors:
Davies, J E; Sen, S; Dehbi, H-M; Al-Lamee, R.; Petraco, R; Nijjer, S S; Bhindi, R; Lehman, S J; Walters, D; Sapontis, J; Janssens, L.; Vrints, C J; Khashaba, A; Laine, M; Van Belle, E; Krackhardt, F; Bojara, W; Going, O; Härle, T; Indolfi, C; Niccoli, G; Ribichini, F; Tanaka, N; Yokoi, H; Takashima, H; Kikuta, Y; Erglis, A; Vinhas, H; Canas Silva, P; Baptista, S B; Alghamdi, A; Hellig, F; Koo, B-K; Nam, C-W; Shin, E-S; Doh, J-H; Brugaletta, S; Alegria-Barrero, E; Meuwissen, M; Piek, J J; van Royen, N; Sezer, M; Di Mario, C; Gerber, R T; Malik, I S; Sharp, Andrew; Talwar, S; Tang, K; Samady, H; Altman, J; Seto, A H; Singh, J; Jeremias, A; Matsuo, H; Kharbanda, R K; Patel, M R; Serruys, P; Escaned, J
Abstract:
Background Coronary revascularization guided by fractional flow reserve (FFR) is associated with better patient outcomes after the procedure than revascularization guided by angiography alone. It is unknown whether the instantaneous wave-free ratio (iFR), an alternative measure that does not require the administration of adenosine, will offer benefits similar to those of FFR. Methods We randomly assigned 2492 patients with coronary artery disease, in a 1:1 ratio, to undergo either iFR-guided or FFR-guided coronary revascularization. The primary end point was the 1-year risk of major adverse cardiac events, which were a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization. The trial was designed to show the noninferiority of iFR to FFR, with a margin of 3.4 percentage points for the difference in risk. Results At 1 year, the primary end point had occurred in 78 of 1148 patients (6.8%) in the iFR group and in 83 of 1182 patients (7.0%) in the FFR group (difference in risk, -0.2 percentage points; 95% confidence interval [CI], -2.3 to 1.8; P<0.001 for noninferiority; hazard ratio, 0.95; 95% CI, 0.68 to 1.33; P=0.78). The risk of each component of the primary end point and of death from cardiovascular or noncardiovascular causes did not differ significantly between the groups. The number of patients who had adverse procedural symptoms and clinical signs was significantly lower in the iFR group than in the FFR group (39 patients [3.1%] vs. 385 patients [30.8%], P<0.001), and the median procedural time was significantly shorter (40.5 minutes vs. 45.0 minutes, P=0.001). Conclusions Coronary revascularization guided by iFR was noninferior to revascularization guided by FFR with respect to the risk of major adverse cardiac events at 1 year. The rate of adverse procedural signs and symptoms was lower and the procedural time was shorter with iFR than with FFR. (Funded by Philips Volcano; DEFINE-FLAIR ClinicalTrials.gov number, NCT02053038 .).
Citation:
Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI. 2017 N. Engl. J. Med.
Publisher:
NEJM
Journal:
The New England Journal of Medicine
Issue Date:
18-Mar-2017
URI:
http://hdl.handle.net/11287/620317
DOI:
10.1056/NEJMoa1700445
PubMed ID:
28317458
Additional Links:
http://www.nejm.org/doi/abs/10.1056/NEJMoa1700445?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov
Note:
Full-text of this article is freely available via the publisher's website, click on the Additional Link above to access it.
Type:
Journal Article
Language:
en
ISSN:
1533-4406
Appears in Collections:
Cardiology; 2017 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorDavies, J Een
dc.contributor.authorSen, Sen
dc.contributor.authorDehbi, H-Men
dc.contributor.authorAl-Lamee, R.en
dc.contributor.authorPetraco, Ren
dc.contributor.authorNijjer, S Sen
dc.contributor.authorBhindi, Ren
dc.contributor.authorLehman, S Jen
dc.contributor.authorWalters, Den
dc.contributor.authorSapontis, Jen
dc.contributor.authorJanssens, L.en
dc.contributor.authorVrints, C Jen
dc.contributor.authorKhashaba, Aen
dc.contributor.authorLaine, Men
dc.contributor.authorVan Belle, Een
dc.contributor.authorKrackhardt, Fen
dc.contributor.authorBojara, Wen
dc.contributor.authorGoing, Oen
dc.contributor.authorHärle, Ten
dc.contributor.authorIndolfi, Cen
dc.contributor.authorNiccoli, Gen
dc.contributor.authorRibichini, Fen
dc.contributor.authorTanaka, Nen
dc.contributor.authorYokoi, Hen
dc.contributor.authorTakashima, Hen
dc.contributor.authorKikuta, Yen
dc.contributor.authorErglis, Aen
dc.contributor.authorVinhas, Hen
dc.contributor.authorCanas Silva, Pen
dc.contributor.authorBaptista, S Ben
dc.contributor.authorAlghamdi, Aen
dc.contributor.authorHellig, Fen
dc.contributor.authorKoo, B-Ken
dc.contributor.authorNam, C-Wen
dc.contributor.authorShin, E-Sen
dc.contributor.authorDoh, J-Hen
dc.contributor.authorBrugaletta, Sen
dc.contributor.authorAlegria-Barrero, Een
dc.contributor.authorMeuwissen, Men
dc.contributor.authorPiek, J Jen
dc.contributor.authorvan Royen, Nen
dc.contributor.authorSezer, Men
dc.contributor.authorDi Mario, Cen
dc.contributor.authorGerber, R Ten
dc.contributor.authorMalik, I Sen
dc.contributor.authorSharp, Andrewen
dc.contributor.authorTalwar, Sen
dc.contributor.authorTang, Ken
dc.contributor.authorSamady, Hen
dc.contributor.authorAltman, Jen
dc.contributor.authorSeto, A Hen
dc.contributor.authorSingh, Jen
dc.contributor.authorJeremias, Aen
dc.contributor.authorMatsuo, Hen
dc.contributor.authorKharbanda, R Ken
dc.contributor.authorPatel, M Ren
dc.contributor.authorSerruys, Pen
dc.contributor.authorEscaned, Jen
dc.date.accessioned2017-03-24T16:10:19Z-
dc.date.available2017-03-24T16:10:19Z-
dc.date.issued2017-03-18-
dc.identifier.citationUse of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI. 2017 N. Engl. J. Med.en
dc.identifier.issn1533-4406-
dc.identifier.pmid28317458-
dc.identifier.doi10.1056/NEJMoa1700445-
dc.identifier.urihttp://hdl.handle.net/11287/620317-
dc.description.abstractBackground Coronary revascularization guided by fractional flow reserve (FFR) is associated with better patient outcomes after the procedure than revascularization guided by angiography alone. It is unknown whether the instantaneous wave-free ratio (iFR), an alternative measure that does not require the administration of adenosine, will offer benefits similar to those of FFR. Methods We randomly assigned 2492 patients with coronary artery disease, in a 1:1 ratio, to undergo either iFR-guided or FFR-guided coronary revascularization. The primary end point was the 1-year risk of major adverse cardiac events, which were a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization. The trial was designed to show the noninferiority of iFR to FFR, with a margin of 3.4 percentage points for the difference in risk. Results At 1 year, the primary end point had occurred in 78 of 1148 patients (6.8%) in the iFR group and in 83 of 1182 patients (7.0%) in the FFR group (difference in risk, -0.2 percentage points; 95% confidence interval [CI], -2.3 to 1.8; P<0.001 for noninferiority; hazard ratio, 0.95; 95% CI, 0.68 to 1.33; P=0.78). The risk of each component of the primary end point and of death from cardiovascular or noncardiovascular causes did not differ significantly between the groups. The number of patients who had adverse procedural symptoms and clinical signs was significantly lower in the iFR group than in the FFR group (39 patients [3.1%] vs. 385 patients [30.8%], P<0.001), and the median procedural time was significantly shorter (40.5 minutes vs. 45.0 minutes, P=0.001). Conclusions Coronary revascularization guided by iFR was noninferior to revascularization guided by FFR with respect to the risk of major adverse cardiac events at 1 year. The rate of adverse procedural signs and symptoms was lower and the procedural time was shorter with iFR than with FFR. (Funded by Philips Volcano; DEFINE-FLAIR ClinicalTrials.gov number, NCT02053038 .).en
dc.language.isoenen
dc.publisherNEJMen
dc.relation.urlhttp://www.nejm.org/doi/abs/10.1056/NEJMoa1700445?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.goven
dc.rightsArchived with thanks to The New England Journal of Medicineen
dc.subjectWessex Classification Subject Headings::Cardiologyen
dc.titleUse of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI.en
dc.typeJournal Articleen
dc.identifier.journalThe New England Journal of Medicineen
dc.description.noteFull-text of this article is freely available via the publisher's website, click on the Additional Link above to access it.en
dc.type.versionIn press (epub ahead of print)en

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