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

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 i...

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Autores: Rodriguez-Leor, Oriol, Millán, Raúl, Pérez de Prado, Armando
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Recursos:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/55446
Acesso em linha:http://hdl.handle.net/10230/55446
http://dx.doi.org/10.1161/CIRCINTERVENTIONS.122.012328
Access Level:acceso abierto
Palavra-chave:Cateterisme
Cor -- Malalties
Angiografia
Ecografia
Prognosi
Estenosi
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spelling 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 StudyRodriguez-Leor, OriolMillán, RaúlPérez de Prado, ArmandoCateterismeCor -- MalaltiesAngiografiaEcografiaPrognosiEstenosiBackground: 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.Lippincott Williams & Wilkins202320232022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/55446http://dx.doi.org/10.1161/CIRCINTERVENTIONS.122.012328reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésCopyright © 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.http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/554462026-06-12T07:21:37Z
dc.title.none.fl_str_mv 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
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
spellingShingle 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
Rodriguez-Leor, Oriol
Cateterisme
Cor -- Malalties
Angiografia
Ecografia
Prognosi
Estenosi
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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.creator.none.fl_str_mv Rodriguez-Leor, Oriol
Millán, Raúl
Pérez de Prado, Armando
author Rodriguez-Leor, Oriol
author_facet Rodriguez-Leor, Oriol
Millán, Raúl
Pérez de Prado, Armando
author_role author
author2 Millán, Raúl
Pérez de Prado, Armando
author2_role author
author
dc.subject.none.fl_str_mv Cateterisme
Cor -- Malalties
Angiografia
Ecografia
Prognosi
Estenosi
topic Cateterisme
Cor -- Malalties
Angiografia
Ecografia
Prognosi
Estenosi
description 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.
publishDate 2022
dc.date.none.fl_str_mv 2022
2023
2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/55446
http://dx.doi.org/10.1161/CIRCINTERVENTIONS.122.012328
url http://hdl.handle.net/10230/55446
http://dx.doi.org/10.1161/CIRCINTERVENTIONS.122.012328
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Lippincott Williams & Wilkins
publisher.none.fl_str_mv Lippincott Williams & Wilkins
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,811543

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