Trial reportJournal of the American College of Cardiology2019
Clinical Events After Deferral of LAD Revascularization Following Physiological Coronary Assessment.
Trial report in Journal of the American College of Cardiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 42 citations in OpenAlex.
- Long-term outcomes after resting full-cycle ratio and deferral of revascularization.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- The Usefulness of Coregistration with iFR in Tandem or Long Diffuse Coronary Lesions: The iLARDI Randomized Clinical Trial.Journal of clinical medicine · 2024Article
- Physiological Assessment with iFR prior to FFR Measurement in Left Main Disease.Cardiovascular intervention and therapeutics · 2024Article
- Predictors of discordance between fractional flow reserve (FFR) and diastolic pressure ratio (dPR) in intermediate coronary lesions.International journal of cardiology. Heart & vasculature · 2023Article
- Clinical use of physiological lesion assessment using pressure guidewires: an expert consensus document of the Japanese association of cardiovascular intervention and therapeutics-update 2022.Cardiovascular intervention and therapeutics · 2022Review
- Impact of physiologically diffuse versus focal pattern of coronary disease on quantitative flow reserve diagnostic accuracy.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2022Article
- Safety of coronary revascularization deferral based on fractional flow reserve and instantaneous wave-free ratio in patients with chronic kidney disease.Cardiology journal · 2022Article
- FFR pressure wire comparative study for drift: piezo resistive versus optical sensor.American journal of cardiovascular disease · 2022Article
- Role of Diabetes Mellitus in Acute Coronary Syndrome Patients with Heart Failure and Midrange Ejection Fraction Who Have Undergone Percutaneous Coronary Intervention: A 3-Year Case-Series Follow-Up Retrospective Study.Diabetes, metabolic syndrome and obesity : targets and therapy · 2021Article
- Physiology-Based Revascularization of Left Main Coronary Artery Disease.Journal of interventional cardiology · 2021Review
- Review
- Non-hyperaemic coronary pressure measurements to guide coronary interventions.Nature reviews. Cardiology · 2020Review
- Nonhyperemic Pressure Ratios Versus Fractional Flow Reserve: What to Do With Discordant Results?Journal of the American Heart Association · 2020Article
- Physiological Assessment of Coronary Lesions in 2020.Current treatment options in cardiovascular medicine · 2020Review
- The year in cardiology: coronary interventions.European heart journal · 2020Article
- High dose escalation of intracoronary adenosine in the assessment of fractional flow reserve: A retrospective cohort study.PloS one · 2020Article
- Current approach to the diagnosis of atherosclerotic coronary artery disease: more questions than answers.Therapeutic advances in chronic disease · 2019Review
- Physiology-Guided Deferral of Percutaneous Coronary Intervention in the Real World.Journal of the Society for Cardiovascular Angiography & InterventionsArticle
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Authors and funding
61 authors at 20 institutions in 18 countries.
Funding
Abstract
backgroundPhysicians are not always comfortable deferring treatment of a stenosis in the left anterior descending (LAD) artery because of the perception that there is a high risk of major adverse cardiac events (MACE). The authors describe, using the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) trial, MACE rates when LAD lesions are deferred, guided by physiological assessment using fractional flow reserve (FFR) or the instantaneous wave-free ratio (iFR).
objectivesThe purpose of this study was to establish the safety of deferring treatment in the LAD using FFR or iFR within the DEFINE-FLAIR trial.
methodsMACE rates at 1 year were compared between groups (iFR and FFR) in patients whose physiological assessment led to LAD lesions being deferred. MACE was defined as a composite of cardiovascular death, myocardial infarction (MI), and unplanned revascularization at 1 year. Patients, and staff performing follow-up, were blinded to whether the decision was made with FFR or iFR. Outcomes were adjusted for age and sex.
resultsA total of 872 patients had lesions deferred in the LAD (421 guided by FFR, 451 guided by iFR). The event rate with iFR was significantly lower than with FFR (2.44% vs. 5.26%; adjusted HR: 0.46; 95% confidence interval [CI]: 0.22 to 0.95; p = 0.04). This was driven by significantly lower unplanned revascularization with iFR and numerically lower MI (unplanned revascularization: 2.22% iFR vs. 4.99% FFR; adjusted HR: 0.44; 95% CI: 0.21 to 0.93; p = 0.03; MI: 0.44% iFR vs. 2.14% FFR; adjusted HR: 0.23; 95% CI: 0.05 to 1.07; p = 0.06).
conclusionsiFR-guided deferral appears to be safe for patients with LAD lesions. Patients in whom iFR-guided deferral was performed had statistically significantly lower event rates than those with FFR-guided deferral.
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