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-Reference-Cited by-同舟云学术

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

Published:2022-11 Issue:11 Volume:15 Page:861-871
ISSN:1941-7640
Container-title:Circulation: Cardiovascular Interventions
language:en
Short-container-title:Circ: Cardiovascular Interventions

Author:

Rodriguez-Leor Oriol¹²³^ORCID,de la Torre Hernández José María⁴⁵,García-Camarero Tamara⁴⁵,García del Blanco Bruno⁶,López-Palop Ramón⁷^ORCID,Fernández-Nofrerías Eduard¹²^ORCID,Cuellas Ramón Carlos⁸,Jiménez-Kockar Marcelo⁹,Jiménez-Mazuecos Jesús¹⁰^ORCID,Fernández Salinas Francisco¹¹^ORCID,Gómez-Lara Josep¹²^ORCID,Brugaletta Salvatore¹³¹⁴¹⁵^ORCID,Alfonso Fernando¹⁶^ORCID,Palma Ricardo⁶^ORCID,Gómez-Menchero Antonio E.¹⁷,Millán Raúl¹⁸^ORCID,Tejada Ponce David¹⁹,Linares Vicente José Antonio²⁰^ORCID,Ojeda Soledad²¹,Pinar Eduardo⁷,Fernández-Pelegrina Estefanía⁹^ORCID,Morales-Ponce Francisco J.²²^ORCID,Cid-Álvarez Ana Belén²²³,Rama-Merchan Juan Carlos²⁴,Molina Navarro Eduardo²⁵,Escaned Javier²⁶²⁷²⁸^ORCID,Pérez de Prado Armando⁸,

Affiliation:

1. Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (O.R.-L., E.F.-N.).

2. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain (O.R.-L., E.F.-N., A.B.C.-A.).

3. Institut de Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain (O.R.-L., E.F.-N.).

4. Cardiology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.M.d.l.T.H., T.G.-C.).

5. Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain (J.M.d.l.T.H., T.G.-C.).

6. Cardiology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain (B.G.d.B., R.P.).

7. Cardiology Department, Hospital Virgen de la Arrixaca, Murcia, Spain (R.L.-P., E.P.).

8. Servicio de Cardiología, Hospital Universitario de León, Spain (C.C.R., A.P.d.P.).

9. Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (M.J.-K., E.F.-P.).

10. Servicio de Cardiología, Complejo Hospitalario Universitario de Albacete, Spain (J.J.-M.).

11. Cardiology Department, Hospital Universitari Joan XXIII, Tarragona, Spain (F.F.S.).

12. Cardiology Department, Hospital Universitari de Bellvitge, L’Hospital de Llobregat, Spain (J.G.-L.).

13. Cardiology Department, Hospital Clínic, Barcelona, Spain (S.B.).

14. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (S.B.).

15. University of Barcelona, Spain (S.B.).

16. Cardiology Department, Hospital de la Princesa, Madrid, Spain (F.A.).

17. Cardiology Department, Hospital Universitario Juan Ramon Jiménez, Huelva, Spain (A.E.G.-M.).

18. Cardiology Department, Hospital del Mar, Barcelona, Spain (R.M.).

19. Cardiology Department, Hospital General Universitario de Castellón, Castellón de la Plana, Spain (D.T.P.).

20. Cardiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain (J.A.L.V.).

21. Division of Interventional Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain (S.O.).

22. University of Cordoba, Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain (S.O.) Cardiology Department, Hospital Universitario de Puerto Real, Spain (F.J.M.-P.).

23. Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain (A.B.C.-A.).

24. Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.C.R.-M.).

25. Cardiology Department, Hospital de Mérida, Extremadura, Spain (E.M.N.).

26. Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain (J.E.).

27. Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdSSC), Madrid, Spain (J.E.).

28. Universidad Complutense de Madrid, Spain (J.E.).

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 mm 2 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. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03767621.

Funder

Philips Volcano

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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