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, De La Torre Hernández, José María, García Camarero, Tamara, García del Blanco, Bruno, López Palop, Ramón, Fernández Nofrerías, Eduard, Cuellas Ramón, Carlos, Jiménez Kockar, Marcelo, Jiménez Mazuecos, Jesús, Fernández Salinas, Francisco, Góme Lara, Josep, Brugaletta, Salvatore, Alfonso, Fernando, Palma, Ricardo, Gómez Menchero, Antonio E., Millán, Raúl, Tejada Ponce, David, Linares Vicente, José Antonio, Ojeda, Soledad, Pinar, Eduardo, Fernández Peregrina, Estefanía, Morales Ponce, Francisco J., Cid Álvarez, Ana Belén, Rama Merchán, Juan Carlos, Molina Navarro, Eduardo, Escaned, Javier, Pérez de Prado, Armando, On Behalf Of The Ilitro-epic07 Study Investigators
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Recursos:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/191660
Acesso em linha:https://hdl.handle.net/2445/191660
Access Level:acceso abierto
Palavra-chave:Artèries coronàries
Coronary arteries
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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, OriolDe La Torre Hernández, José MaríaGarcía Camarero, TamaraGarcía del Blanco, BrunoLópez Palop, RamónFernández Nofrerías, EduardCuellas Ramón, CarlosJiménez Kockar, MarceloJiménez Mazuecos, JesúsFernández Salinas, FranciscoGóme Lara, JosepBrugaletta, SalvatoreAlfonso, FernandoPalma, RicardoGómez Menchero, Antonio E.Millán, RaúlTejada Ponce, DavidLinares Vicente, José AntonioOjeda, SoledadPinar, EduardoFernández Peregrina, EstefaníaMorales Ponce, Francisco J.Cid Álvarez, Ana BelénRama Merchán, Juan CarlosMolina Navarro, EduardoEscaned, JavierPérez de Prado, ArmandoOn Behalf Of The Ilitro-epic07 Study InvestigatorsArtèries coronàriesCoronary arteriesBackground: 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 & GE;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.Ovid Technologies (Wolters Kluwer Health)2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/191660Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1161/CIRCINTERVENTIONS.122.012328Circulation: Cardiovascular Interventions, 2022, vol. 15, issue. 11, p. 861-871https://doi.org/10.1161/CIRCINTERVENTIONS.122.012328cc by (c) Rodriguez Leor, Oriol et al., 2022http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1916602026-05-27T06:46:51Z
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
Artèries coronàries
Coronary arteries
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
De La Torre Hernández, José María
García Camarero, Tamara
García del Blanco, Bruno
López Palop, Ramón
Fernández Nofrerías, Eduard
Cuellas Ramón, Carlos
Jiménez Kockar, Marcelo
Jiménez Mazuecos, Jesús
Fernández Salinas, Francisco
Góme Lara, Josep
Brugaletta, Salvatore
Alfonso, Fernando
Palma, Ricardo
Gómez Menchero, Antonio E.
Millán, Raúl
Tejada Ponce, David
Linares Vicente, José Antonio
Ojeda, Soledad
Pinar, Eduardo
Fernández Peregrina, Estefanía
Morales Ponce, Francisco J.
Cid Álvarez, Ana Belén
Rama Merchán, Juan Carlos
Molina Navarro, Eduardo
Escaned, Javier
Pérez de Prado, Armando
On Behalf Of The Ilitro-epic07 Study Investigators
author Rodriguez Leor, Oriol
author_facet Rodriguez Leor, Oriol
De La Torre Hernández, José María
García Camarero, Tamara
García del Blanco, Bruno
López Palop, Ramón
Fernández Nofrerías, Eduard
Cuellas Ramón, Carlos
Jiménez Kockar, Marcelo
Jiménez Mazuecos, Jesús
Fernández Salinas, Francisco
Góme Lara, Josep
Brugaletta, Salvatore
Alfonso, Fernando
Palma, Ricardo
Gómez Menchero, Antonio E.
Millán, Raúl
Tejada Ponce, David
Linares Vicente, José Antonio
Ojeda, Soledad
Pinar, Eduardo
Fernández Peregrina, Estefanía
Morales Ponce, Francisco J.
Cid Álvarez, Ana Belén
Rama Merchán, Juan Carlos
Molina Navarro, Eduardo
Escaned, Javier
Pérez de Prado, Armando
On Behalf Of The Ilitro-epic07 Study Investigators
author_role author
author2 De La Torre Hernández, José María
García Camarero, Tamara
García del Blanco, Bruno
López Palop, Ramón
Fernández Nofrerías, Eduard
Cuellas Ramón, Carlos
Jiménez Kockar, Marcelo
Jiménez Mazuecos, Jesús
Fernández Salinas, Francisco
Góme Lara, Josep
Brugaletta, Salvatore
Alfonso, Fernando
Palma, Ricardo
Gómez Menchero, Antonio E.
Millán, Raúl
Tejada Ponce, David
Linares Vicente, José Antonio
Ojeda, Soledad
Pinar, Eduardo
Fernández Peregrina, Estefanía
Morales Ponce, Francisco J.
Cid Álvarez, Ana Belén
Rama Merchán, Juan Carlos
Molina Navarro, Eduardo
Escaned, Javier
Pérez de Prado, Armando
On Behalf Of The Ilitro-epic07 Study Investigators
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Artèries coronàries
Coronary arteries
topic Artèries coronàries
Coronary arteries
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 & GE;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.
publishDate 2022
dc.date.none.fl_str_mv 2022
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 https://hdl.handle.net/2445/191660
url https://hdl.handle.net/2445/191660
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1161/CIRCINTERVENTIONS.122.012328
Circulation: Cardiovascular Interventions, 2022, vol. 15, issue. 11, p. 861-871
https://doi.org/10.1161/CIRCINTERVENTIONS.122.012328
dc.rights.none.fl_str_mv cc by (c) Rodriguez Leor, Oriol et al., 2022
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by (c) Rodriguez Leor, Oriol et al., 2022
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Ovid Technologies (Wolters Kluwer Health)
publisher.none.fl_str_mv Ovid Technologies (Wolters Kluwer Health)
dc.source.none.fl_str_mv Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300719

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