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Hybrid iFR-FFR decision-making strategy: implications for enhancing universal adoption of physiology-guided coronary revascularisation

2013; European Association of Percutaneous Cardiovascular Interventions; Volume: 8; Issue: 10 Linguagem: Inglês

10.4244/eijv8i10a179

1969-6213

Ricardo Petraco, Jin Joo Park, Sayan Sen, Sukhjinder Nijjer, Iqbal Malik, Mauro Echavarría‐Pinto, Kaleab Asrress, Chang‐Wook Nam, Enrico Macías, Rodney A. Foale, Amarjit Sethi, Ghada Mikhail, Raffi Kaprielian, Christopher Baker, David Lefroy, Michael Bellamy, Mahmud Al‐Bustami, Masood Khan, Nieves Gonzalo, Alun D. Hughes, Dárrel P. Francis, Jamil Mayet, Carlo Di Mario, Simon Redwood, Javier Escaned, Bon‐Kwon Koo, Justin E. Davies,

Acute Myocardial Infarction Research

Adoption of fractional flow reserve (FFR) remains low (6-8%), partly because of the time, cost and potential inconvenience associated with vasodilator administration. The instantaneous wave-Free Ratio (iFR) is a pressure-only index of stenosis severity calculated without vasodilator drugs. Before outcome trials test iFR as a sole guide to revascularisation, we evaluate the merits of a hybrid iFR-FFR decision-making strategy for universal physiological assessment.Coronary pressure traces from 577 stenoses were analysed. iFR was calculated as the ratio between Pd and Pa in the resting diastolic wave-free window. A hybrid iFR-FFR strategy was evaluated, by allowing iFR to defer some stenoses (where negative predictive value is high) and treat others (where positive predictive value is high), with adenosine being given only to patients with iFR in between those values. For the most recent fixed FFR cut-off (0.8), an iFR of 0.93 could be used to defer revascularisation (NPV of 91%). Limiting vasodilator drugs to cases with iFR values between 0.86 to 0.93 would obviate the need for vasodilator drugs in 57% of patients, whilst maintaining 95% agreement with an FFR-only strategy. If the 0.75-0.8 FFR grey zone is accounted for, vasodilator drug requirement would decrease by 76%.A hybrid iFR-FFR decision-making strategy for revascularisation could increase adoption of physiology-guided PCI, by more than halving the need for vasodilator administration, whilst maintaining high classification agreement with an FFR-only strategy.