Physiological Assessment with iFR prior to FFR Measurement in Left Main Disease

• DOI: 10.1007/s12928-024-00989-4
• Publication Date: 2024-04-20T06:02:01Z
• Authors: Takayuki Warisawa; Christopher M. Cook; Yousif Ahmad; James P. Howard; Henry Seligman; Christopher Rajkumar; Takumi Toya; Shunichi Doi; Akihiro Nakajima; Masafumi Nakayama; Rafael Vera-Urquiza; Sonoka Yuasa; Takao Sato; Yuetsu Kikuta; Yoshiaki Kawase; Hidetaka Nishina; Rasha Al-Lamee; Sayan Sen; Amir Lerman; Hitoshi Matsuo; Yoshihiro J. Akashi; Javier Escaned; Justin E. Davies
• Keywords: Interventional radiology

Despite guideline-based recommendation of the interchangeable use instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) to guide revascularization decision-making, iFR/FFR could demonstrate different physiological or clinical outcomes in some specific patient lesion subsets. Therefore, we sought investigate impact difference between iFR FFR-guided decision-making on patients with left main disease (LMD). In this international multicenter registry LMD interrogation, identified 275 whom assessment was performed both iFR/FFR. Major adverse cardiovascular event (MACE) defined as a composite death, non-fatal myocardial infarction, ischemia-driven target revascularization. The receiver-operating characteristic analysis for predict MACE respective deferred performed. 153 deferral, occurred 17.0% patients. optimal cut-off values FFR were 0.88 (specificity:0.74; sensitivity:0.65) 0.76 (specificity:0.81; sensitivity:0.46), respectively. area under curve (AUC) significantly higher than (0.74; 95%CI 0.62-0.85 vs. 0.62; 0.48-0.75; p = 0.012). 122 coronary revascularization, 13.1% 0.92 (specificity:0.93; sensitivity:0.25) 0.81 (specificity:0.047; sensitivity:1.00), AUCs not (0.57; 0.40-0.73 0.46; 0.31-0.61; 0.43). While neither baseline nor predictive performed, iFR-guided deferral seemed be safer deferral.