Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). Assessment of coro...

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Published inJACC. Cardiovascular interventions Vol. 11; no. 15; pp. 1437 - 1449
Main Authors Escaned, Javier, Ryan, Nicola, Mejía-Rentería, Hernán, Cook, Christopher M., Dehbi, Hakim-Moulay, Alegria-Barrero, Eduardo, Alghamdi, Ali, Al-Lamee, Rasha, Altman, John, Ambrosia, Alphonse, Baptista, Sérgio B., Bertilsson, Maria, Bhindi, Ravinay, Birgander, Mats, Bojara, Waldemar, Brugaletta, Salvatore, Buller, Christopher, Calais, Fredrik, Silva, Pedro Canas, Carlsson, Jörg, Christiansen, Evald H., Danielewicz, Mikael, Di Mario, Carlo, Doh, Joon-Hyung, Erglis, Andrejs, Erlinge, David, Gerber, Robert T., Going, Olaf, Gudmundsdottir, Ingibjörg, Härle, Tobias, Hauer, Dario, Hellig, Farrel, Indolfi, Ciro, Jakobsen, Lars, Janssens, Luc, Jensen, Jens, Jeremias, Allen, Kåregren, Amra, Karlsson, Ann-Charlotte, Kharbanda, Rajesh K., Khashaba, Ahmed, Kikuta, Yuetsu, Krackhardt, Florian, Koo, Bon-Kwon, Koul, Sasha, Laine, Mika, Lehman, Sam J., Lindroos, Pontus, Malik, Iqbal S., Maeng, Michael, Matsuo, Hitoshi, Meuwissen, Martijn, Nam, Chang-Wook, Niccoli, Giampaolo, Nijjer, Sukhjinder S., Olsson, Hans, Olsson, Sven-Erik, Omerovic, Elmir, Panayi, Georgios, Petraco, Ricardo, Piek, Jan J., Ribichini, Flavo, Samady, Habib, Samuels, Bruce, Sandhall, Lennart, Sapontis, James, Sen, Sayan, Seto, Arnold H., Sezer, Murat, Sharp, Andrew S.P., Shin, Eun-Seok, Singh, Jasvindar, Takashima, Hiroaki, Talwar, Suneel, Tanaka, Nobuhiro, Tang, Kare, Van Belle, Eric, van Royen, Niels, Varenhorst, Christoph, Vinhas, Hugo, Vrints, Christiaan J., Walters, Darren, Yokoi, Hiroyoshi, Fröbert, Ole, Patel, Manesh R., Serruys, Patrick, Davies, Justin E., Götberg, Matthias
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 13.08.2018
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Abstract The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. [Display omitted]
AbstractList OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p &lt; 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
OBJECTIVES: The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND: Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS: The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS: Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p &lt; 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS: Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year.
OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p amp;lt; 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. [Display omitted]
Objectives: The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). Background: Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. Methods: The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. Results: Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). Conclusions: Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year.
OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p &lt; 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year.
The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS).OBJECTIVESThe aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS).Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization.BACKGROUNDAssessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization.The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year.METHODSThe safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year.Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04).RESULTSCoronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04).Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year.CONCLUSIONSOverall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year.
Objectives: The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). Background: Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. Methods: The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was majoradverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. Results: Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). Conclusions: Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferredpatients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year.
The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year.
Author Bertilsson, Maria
Calais, Fredrik
Yokoi, Hiroyoshi
Cook, Christopher M.
Koul, Sasha
Going, Olaf
Matsuo, Hitoshi
Omerovic, Elmir
Serruys, Patrick
Vrints, Christiaan J.
Sapontis, James
Danielewicz, Mikael
Hauer, Dario
Maeng, Michael
Patel, Manesh R.
Härle, Tobias
Doh, Joon-Hyung
Lindroos, Pontus
Mejía-Rentería, Hernán
Krackhardt, Florian
Al-Lamee, Rasha
Samuels, Bruce
Talwar, Suneel
Birgander, Mats
Olsson, Sven-Erik
Altman, John
Kharbanda, Rajesh K.
Laine, Mika
Nam, Chang-Wook
Samady, Habib
Walters, Darren
Jakobsen, Lars
Singh, Jasvindar
Jensen, Jens
Jeremias, Allen
Ryan, Nicola
Koo, Bon-Kwon
Christiansen, Evald H.
Tang, Kare
Escaned, Javier
Erglis, Andrejs
Nijjer, Sukhjinder S.
Vinhas, Hugo
Meuwissen, Martijn
Indolfi, Ciro
Ribichini, Flavo
Malik, Iqbal S.
Götberg, Matthias
Dehbi, Hakim-Moulay
Di Mario, Carlo
Piek, Jan J.
Lehman, Sam J.
Buller, Christopher
Hellig, Farrel
Petraco, Ricardo
Sandhall, Lennart
Seto, Arnold H.
Niccoli, Giampaolo
Shin, Eun-Seok
Takashima, Hiroaki
Carlsson, Jörg
Olsson, Hans
Silva, Pedro Canas
Fröbert, Ole
Baptista, Sérgio B
Author_xml – sequence: 1
  givenname: Javier
  surname: Escaned
  fullname: Escaned, Javier
  organization: Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
– sequence: 2
  givenname: Nicola
  surname: Ryan
  fullname: Ryan, Nicola
  organization: Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
– sequence: 3
  givenname: Hernán
  surname: Mejía-Rentería
  fullname: Mejía-Rentería, Hernán
  organization: Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
– sequence: 4
  givenname: Christopher M.
  surname: Cook
  fullname: Cook, Christopher M.
  organization: Hammersmith Hospital, Imperial College London, London, United Kingdom
– sequence: 5
  givenname: Hakim-Moulay
  surname: Dehbi
  fullname: Dehbi, Hakim-Moulay
  organization: CRUK & UCL Cancer Trials Centre, University College London, London, United Kingdom
– sequence: 6
  givenname: Eduardo
  surname: Alegria-Barrero
  fullname: Alegria-Barrero, Eduardo
  organization: Hospital Universitario de Torrejón and Universidad Francisco de Vitoria, Madrid, Spain
– sequence: 7
  givenname: Ali
  surname: Alghamdi
  fullname: Alghamdi, Ali
  organization: King Abdulaziz Medical City Cardiac Center, Riyadh, Saudi Arabia
– sequence: 8
  givenname: Rasha
  surname: Al-Lamee
  fullname: Al-Lamee, Rasha
  organization: Hammersmith Hospital, Imperial College London, London, United Kingdom
– sequence: 9
  givenname: John
  surname: Altman
  fullname: Altman, John
  organization: Colorado Heart and Vascular, Lakewood, Colorado
– sequence: 10
  givenname: Alphonse
  surname: Ambrosia
  fullname: Ambrosia, Alphonse
  organization: Mesa, Arizona
– sequence: 11
  givenname: Sérgio B.
  surname: Baptista
  fullname: Baptista, Sérgio B.
  organization: Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
– sequence: 12
  givenname: Maria
  surname: Bertilsson
  fullname: Bertilsson, Maria
  organization: Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
– sequence: 13
  givenname: Ravinay
  surname: Bhindi
  fullname: Bhindi, Ravinay
  organization: Royal North Shore Hospital, Sydney, Australia
– sequence: 14
  givenname: Mats
  surname: Birgander
  fullname: Birgander, Mats
  organization: Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
– sequence: 15
  givenname: Waldemar
  surname: Bojara
  fullname: Bojara, Waldemar
  organization: Gemeinschaftsklinikum Mittelrhein, Kemperhof Koblenz, Koblenz, Germany
– sequence: 16
  givenname: Salvatore
  surname: Brugaletta
  fullname: Brugaletta, Salvatore
  organization: Cardiovascular Institute, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
– sequence: 17
  givenname: Christopher
  surname: Buller
  fullname: Buller, Christopher
  organization: St. Michaels Hospital, Toronto, Ontario, Canada
– sequence: 18
  givenname: Fredrik
  surname: Calais
  fullname: Calais, Fredrik
  organization: Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
– sequence: 19
  givenname: Pedro Canas
  surname: Silva
  fullname: Silva, Pedro Canas
  organization: Hospital Santa Maria, Lisbon, Portugal
– sequence: 20
  givenname: Jörg
  surname: Carlsson
  fullname: Carlsson, Jörg
  organization: Kalmar County Hospital, and Linnaeus University, Faculty of Health and Life Sciences, Kalmar, Sweden
– sequence: 21
  givenname: Evald H.
  surname: Christiansen
  fullname: Christiansen, Evald H.
  organization: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
– sequence: 22
  givenname: Mikael
  surname: Danielewicz
  fullname: Danielewicz, Mikael
  organization: Department of Cardiology, Karlstad Hospital, Karlstad, Sweden
– sequence: 23
  givenname: Carlo
  surname: Di Mario
  fullname: Di Mario, Carlo
  organization: Royal Brompton Hospital, Imperial College London, United Kingdom, and University of Florence, Florence, Italy
– sequence: 24
  givenname: Joon-Hyung
  surname: Doh
  fullname: Doh, Joon-Hyung
  organization: Inje University Ilsan Paik Hospital, Daehwa-Dong, South Korea
– sequence: 25
  givenname: Andrejs
  surname: Erglis
  fullname: Erglis, Andrejs
  organization: Pauls Stradins Clinical University Hospital, Riga, Latvia
– sequence: 26
  givenname: David
  surname: Erlinge
  fullname: Erlinge, David
  organization: Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
– sequence: 27
  givenname: Robert T.
  surname: Gerber
  fullname: Gerber, Robert T.
  organization: Conquest Hospital, St. Leonards-on-Sea, United Kingdom
– sequence: 28
  givenname: Olaf
  surname: Going
  fullname: Going, Olaf
  organization: Sana Klinikum Lichtenberg, Lichtenberg, Germany
– sequence: 29
  givenname: Ingibjörg
  surname: Gudmundsdottir
  fullname: Gudmundsdottir, Ingibjörg
  organization: Department of Cardiology, Reykjavik University Hospital, Reykjavik, Iceland
– sequence: 30
  givenname: Tobias
  surname: Härle
  fullname: Härle, Tobias
  organization: Klinikum Oldenburg, European Medical School, Carl von Ossietzky University, Oldenburg, Germany
– sequence: 31
  givenname: Dario
  surname: Hauer
  fullname: Hauer, Dario
  organization: Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden
– sequence: 32
  givenname: Farrel
  surname: Hellig
  fullname: Hellig, Farrel
  organization: Sunninghill Hospital, Johannesburg, South Africa
– sequence: 33
  givenname: Ciro
  surname: Indolfi
  fullname: Indolfi, Ciro
  organization: University Magna Graecia, Catanzaro, Italy
– sequence: 34
  givenname: Lars
  surname: Jakobsen
  fullname: Jakobsen, Lars
  organization: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
– sequence: 35
  givenname: Luc
  surname: Janssens
  fullname: Janssens, Luc
  organization: Imelda Hospital, Bonheiden, Belgium
– sequence: 36
  givenname: Jens
  surname: Jensen
  fullname: Jensen, Jens
  organization: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Unit of Cardiology, Capio S:t Görans Sjukhus, Stockholm, and Department of Medicine, Sundsvall Hospital, Sundsvall, Sweden
– sequence: 37
  givenname: Allen
  surname: Jeremias
  fullname: Jeremias, Allen
  organization: Stony Brook University Medical Center, Stony Brook, New York
– sequence: 38
  givenname: Amra
  surname: Kåregren
  fullname: Kåregren, Amra
  organization: Department of Internal Medicine, Västmanland Hospital Västerås, Västerås, Sweden
– sequence: 39
  givenname: Ann-Charlotte
  surname: Karlsson
  fullname: Karlsson, Ann-Charlotte
  organization: Department of Cardiology, Halmstad Hospital, Halmstad, Sweden
– sequence: 40
  givenname: Rajesh K.
  surname: Kharbanda
  fullname: Kharbanda, Rajesh K.
  organization: John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford, United Kingdom
– sequence: 41
  givenname: Ahmed
  surname: Khashaba
  fullname: Khashaba, Ahmed
  organization: Ain Shams University, Cairo, Egypt
– sequence: 42
  givenname: Yuetsu
  surname: Kikuta
  fullname: Kikuta, Yuetsu
  organization: Fukuyama Cardiovascular Hospital, Fukuyama, Japan
– sequence: 43
  givenname: Florian
  surname: Krackhardt
  fullname: Krackhardt, Florian
  organization: Charite Campus Virchow Klinikum, Universitaetsmedizin, Berlin, Germany
– sequence: 44
  givenname: Bon-Kwon
  surname: Koo
  fullname: Koo, Bon-Kwon
  organization: Seoul National University Hospital, Seoul, South Korea
– sequence: 45
  givenname: Sasha
  surname: Koul
  fullname: Koul, Sasha
  organization: Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
– sequence: 46
  givenname: Mika
  surname: Laine
  fullname: Laine, Mika
  organization: Helsinki University Hospital, Helsinki, Finland
– sequence: 47
  givenname: Sam J.
  surname: Lehman
  fullname: Lehman, Sam J.
  organization: Flinders University, Adelaide, Australia
– sequence: 48
  givenname: Pontus
  surname: Lindroos
  fullname: Lindroos, Pontus
  organization: Department of Cardiology, St. Göran Hospital, Stockholm, Sweden
– sequence: 49
  givenname: Iqbal S.
  surname: Malik
  fullname: Malik, Iqbal S.
  organization: Hammersmith Hospital, Imperial College London, London, United Kingdom
– sequence: 50
  givenname: Michael
  surname: Maeng
  fullname: Maeng, Michael
  organization: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
– sequence: 51
  givenname: Hitoshi
  surname: Matsuo
  fullname: Matsuo, Hitoshi
  organization: Gifu Heart Center, Gifu, Japan
– sequence: 52
  givenname: Martijn
  surname: Meuwissen
  fullname: Meuwissen, Martijn
  organization: Amphia Hospital, Breda, the Netherlands
– sequence: 53
  givenname: Chang-Wook
  surname: Nam
  fullname: Nam, Chang-Wook
  organization: Keimyung University Dongsan Medical Center, Daegu, South Korea
– sequence: 54
  givenname: Giampaolo
  surname: Niccoli
  fullname: Niccoli, Giampaolo
  organization: Catholic University of the Sacred Heart, Rome, Italy
– sequence: 55
  givenname: Sukhjinder S.
  surname: Nijjer
  fullname: Nijjer, Sukhjinder S.
  organization: Hammersmith Hospital, Imperial College London, London, United Kingdom
– sequence: 56
  givenname: Hans
  surname: Olsson
  fullname: Olsson, Hans
  organization: Department of Cardiology, Karlstad Hospital, Karlstad, Sweden
– sequence: 57
  givenname: Sven-Erik
  surname: Olsson
  fullname: Olsson, Sven-Erik
  organization: Departments of Cardiology and Radiology, Helsingborg Hospital, Helsingborg, Sweden
– sequence: 58
  givenname: Elmir
  surname: Omerovic
  fullname: Omerovic, Elmir
  organization: Department of Cardiology, Sahlgrenska University Gothenburg, Sweden
– sequence: 59
  givenname: Georgios
  surname: Panayi
  fullname: Panayi, Georgios
  organization: Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden
– sequence: 60
  givenname: Ricardo
  surname: Petraco
  fullname: Petraco, Ricardo
  organization: Hammersmith Hospital, Imperial College London, London, United Kingdom
– sequence: 61
  givenname: Jan J.
  surname: Piek
  fullname: Piek, Jan J.
  organization: AMC Heart Center, Academic Medical Center, Amsterdam, the Netherlands
– sequence: 62
  givenname: Flavo
  surname: Ribichini
  fullname: Ribichini, Flavo
  organization: University Hospital Verona, Verona, Italy
– sequence: 63
  givenname: Habib
  surname: Samady
  fullname: Samady, Habib
  organization: Emory University, Atlanta, Georgia
– sequence: 64
  givenname: Bruce
  surname: Samuels
  fullname: Samuels, Bruce
  organization: Cedars-Sinai Heart Institute, Los Angeles, California
– sequence: 65
  givenname: Lennart
  surname: Sandhall
  fullname: Sandhall, Lennart
  organization: Departments of Cardiology and Radiology, Helsingborg Hospital, Helsingborg, Sweden
– sequence: 66
  givenname: James
  surname: Sapontis
  fullname: Sapontis, James
  organization: MonashHeart and Monash University, Melbourne, Australia
– sequence: 67
  givenname: Sayan
  surname: Sen
  fullname: Sen, Sayan
  organization: Hammersmith Hospital, Imperial College London, London, United Kingdom
– sequence: 68
  givenname: Arnold H.
  surname: Seto
  fullname: Seto, Arnold H.
  organization: Veterans Affairs Long Beach Healthcare System, Long Beach, California
– sequence: 69
  givenname: Murat
  surname: Sezer
  fullname: Sezer, Murat
  organization: Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
– sequence: 70
  givenname: Andrew S.P.
  surname: Sharp
  fullname: Sharp, Andrew S.P.
  organization: Royal Devon and Exeter Hospital and University of Exeter, Exeter, United Kingdom
– sequence: 71
  givenname: Eun-Seok
  surname: Shin
  fullname: Shin, Eun-Seok
  organization: Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
– sequence: 72
  givenname: Jasvindar
  surname: Singh
  fullname: Singh, Jasvindar
  organization: Washington University School of Medicine, St. Louis, Missouri
– sequence: 73
  givenname: Hiroaki
  surname: Takashima
  fullname: Takashima, Hiroaki
  organization: Aichi Medical University Hospital, Aichi, Japan
– sequence: 74
  givenname: Suneel
  surname: Talwar
  fullname: Talwar, Suneel
  organization: Royal Bournemouth General Hospital, Bournemouth, United Kingdom
– sequence: 75
  givenname: Nobuhiro
  surname: Tanaka
  fullname: Tanaka, Nobuhiro
  organization: Tokyo Medical University, Tokyo, Japan
– sequence: 76
  givenname: Kare
  surname: Tang
  fullname: Tang, Kare
  organization: Essex Cardiothoracic Centre, Basildon and Anglia Ruskin University, Chelmsford, United Kingdom
– sequence: 77
  givenname: Eric
  surname: Van Belle
  fullname: Van Belle, Eric
  organization: Institut Coeur Poumon, Lille University Hospital, and INSERM Unité 1011, Lille, France
– sequence: 78
  givenname: Niels
  surname: van Royen
  fullname: van Royen, Niels
  organization: VU University Medical Center, Amsterdam, the Netherlands
– sequence: 79
  givenname: Christoph
  surname: Varenhorst
  fullname: Varenhorst, Christoph
  organization: Department of Medical Sciences, Uppsala University, Uppsala, Sweden
– sequence: 80
  givenname: Hugo
  surname: Vinhas
  fullname: Vinhas, Hugo
  organization: Hospital Garcia de Horta, Lisbon, Portugal
– sequence: 81
  givenname: Christiaan J.
  surname: Vrints
  fullname: Vrints, Christiaan J.
  organization: Antwerp University Hospital, Antwerp, Belgium
– sequence: 82
  givenname: Darren
  surname: Walters
  fullname: Walters, Darren
  organization: Prince Charles Hospital, Brisbane, Australia
– sequence: 83
  givenname: Hiroyoshi
  surname: Yokoi
  fullname: Yokoi, Hiroyoshi
  organization: Fukuoka Sannou Hospital, Fukuoka, Japan
– sequence: 84
  givenname: Ole
  surname: Fröbert
  fullname: Fröbert, Ole
  organization: Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
– sequence: 85
  givenname: Manesh R.
  surname: Patel
  fullname: Patel, Manesh R.
  organization: Duke University, Durham, North Carolina
– sequence: 86
  givenname: Patrick
  surname: Serruys
  fullname: Serruys, Patrick
  organization: Department of Cardiology, Imperial College London, London, United Kingdom
– sequence: 87
  givenname: Justin E.
  surname: Davies
  fullname: Davies, Justin E.
  email: justindavies@heart123.com
  organization: Hammersmith Hospital, Imperial College London, London, United Kingdom
– sequence: 88
  givenname: Matthias
  surname: Götberg
  fullname: Götberg, Matthias
  organization: Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
BackLink https://www.ncbi.nlm.nih.gov/pubmed/30093050$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Copyright 2018 The Authors
Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.
Copyright_xml – notice: 2018 The Authors
– notice: Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.
CorporateAuthor Kardiologi
Department of Clinical Sciences, Lund
Molekylär kardiologi
Molecular Cardiology
Faculty of Medicine
Institutionen för kliniska vetenskaper, Lund
Sektion II
Section II
Lunds universitet
Medicinska fakulteten
Lund University
Cardiology
CorporateAuthor_xml – name: Faculty of Medicine
– name: Department of Clinical Sciences, Lund
– name: Medicinska fakulteten
– name: Sektion II
– name: Molekylär kardiologi
– name: Kardiologi
– name: Section II
– name: Lund University
– name: Cardiology
– name: Institutionen för kliniska vetenskaper, Lund
– name: Molecular Cardiology
– name: Lunds universitet
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DOI 10.1016/j.jcin.2018.05.029
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Issue 15
Keywords ACS
deferral of revascularization
FFR
SAP
iFR
MACE
CI
PCI
HR
MI
coronary physiology
Language English
License This is an open access article under the CC BY-NC-ND license.
Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.
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Snippet The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free...
OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous...
OBJECTIVES: The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous...
Objectives: The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous...
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StartPage 1437
SubjectTerms ACS
Acute Coronary Syndrome - diagnosis
Acute Coronary Syndrome - physiopathology
Acute Coronary Syndrome - therapy
Aged
Angina, Stable - diagnosis
Angina, Stable - physiopathology
Angina, Stable - therapy
Cardiac and Cardiovascular Systems
Cardiac Catheterization
Cardiology and Cardiovascular Disease
Clinical Decision-Making
Clinical Medicine
Coronary Artery Disease - diagnosis
Coronary Artery Disease - physiopathology
Coronary Artery Disease - therapy
coronary physiology
Coronary Stenosis - diagnosis
Coronary Stenosis - physiopathology
Coronary Stenosis - therapy
deferral of revascularization
Female
FFR
Fractional Flow Reserve, Myocardial
Humans
iFR
Kardiologi
Kardiologi och kardiovaskulära sjukdomar
Klinisk medicin
Male
Medical and Health Sciences
Medicin och hälsovetenskap
Middle Aged
Myocardial Revascularization - adverse effects
Nursing
Omvårdnad
Patient Selection
Predictive Value of Tests
Randomized Controlled Trials as Topic
Risk Factors
SAP
Time Factors
Time-to-Treatment
Treatment Outcome
Title Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes
URI https://www.clinicalkey.com/#!/content/1-s2.0-S1936879818311439
https://dx.doi.org/10.1016/j.jcin.2018.05.029
https://www.ncbi.nlm.nih.gov/pubmed/30093050
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