BibTex format
@article{Li:2025:10.1016/j.jcin.2025.05.033,
author = {Li, Kam Wa ME and Ezad, SM and Modi, B and Demir, OM and Hinton, J and Ellis, H and De, Silva K and Gulati, A and De, Silva R and OKane, P and Douiri, A and Collison, D and Curzen, N and Collet, C and Perera, D},
doi = {10.1016/j.jcin.2025.05.033},
journal = {JACC: Cardiovascular Interventions},
pages = {1617--1627},
title = {Randomized comparison of fractional flow reserve and instantaneous wave free ratio in serial disease},
url = {http://dx.doi.org/10.1016/j.jcin.2025.05.033},
volume = {18},
year = {2025}
}
RIS format (EndNote, RefMan)
TY - JOUR
AB - BackgroundFractional flow reserve (FFR) and the instantaneous wave-free ratio (iFR) identify arteries that benefit from percutaneous coronary intervention (PCI). FFR or iFR gradients on pullback are often used to predict the physiological result (FFRΔ or iFRΔ), but this approach is unvalidated.ObjectivesThe aim of this study was to compare the accuracy of FFRΔ, iFRΔ and FFRcalc (a mathematical solution incorporating interaction between lesions) for predicting post-PCI physiology in serial or diffuse disease.MethodsPatients with a focal target lesion and either a second focal lesion or a diffusely diseased segment in the same vessel were randomized to FFR- vs iFR-guided PCI (ISRCTN18106869). FFR and iFR pullbacks were performed, with operators blinded to one modality. Following target lesion PCI, FFR and iFR were remeasured. The primary outcome was the error in predicted post-PCI physiology compared with actual values.ResultsA total of 87 patients were randomized to FFR (n = 45) or iFR (n = 42). Median FFR and iFR were 0.70 (Q1-Q3: 0.62 to 0.78) and 0.81 (Q1-Q3: 0.68 to 0.90) at baseline and 0.82 (Q1-Q3: 0.74 to 0.87) and 0.89 (Q1-Q3: 0.83 to 0.93) after target lesion PCI. The predictive errors were 12% (6% to 17%) for FFRΔ, 4% (0% to 9%; P < 0.001) for iFRΔ, and −5% (−18% to 8%; P = 0.427) for FFRcalc. Significant residual disease was missed in 36% of cases with FFRΔ, 34% with iFRΔ, and 14% with FFRcalc.ConclusionsFFR and iFR pullback gradients overestimate the benefit of target lesion PCI and can miss residual ischemia in one-third of patients. FFR or iFR should be routinely repeated post-PCI in serial disease.
AU - Li,Kam Wa ME
AU - Ezad,SM
AU - Modi,B
AU - Demir,OM
AU - Hinton,J
AU - Ellis,H
AU - De,Silva K
AU - Gulati,A
AU - De,Silva R
AU - OKane,P
AU - Douiri,A
AU - Collison,D
AU - Curzen,N
AU - Collet,C
AU - Perera,D
DO - 10.1016/j.jcin.2025.05.033
EP - 1627
PY - 2025///
SN - 1936-8798
SP - 1617
TI - Randomized comparison of fractional flow reserve and instantaneous wave free ratio in serial disease
T2 - JACC: Cardiovascular Interventions
UR - http://dx.doi.org/10.1016/j.jcin.2025.05.033
UR - https://doi.org/10.1016/j.jcin.2025.05.033
VL - 18
ER -