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Cited by 979

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Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI

Open access
Davies, Justin E., Sen, Sayan, Dehbi, Hakim-Moulay, Al-Lamee, Rasha, Petraco, Ricardo, Nijjer, Sukhjinder S., Bhindi, Ravinay, Lehman, Sam J., Walters, Darren, Sapontis, James, Janssens, Luc, Vrints, Christiaan J., Khashaba, Ahmed, Laine, Mika, Van Belle, Eric, Krackhardt, Florian, Bojara, Waldemar, Going, Olaf, Härle, Tobias, Indolfi, Ciro, Niccoli, Giampaolo, Ribichini, Flavo, Tanaka, Nobuhiro, Yokoi, Hiroyoshi, Takashima, Hiroaki, Kikuta, Yuetsu, Erglis, Andrejs, Vinhas, Hugo, Canas Silva, Pedro, Baptista, Sérgio B., Alghamdi, Ali, Hellig, Farrel, Koo, Bon-Kwon, Nam, Chang-Wook, Shin, Eun-Seok, Doh, Joon-Hyung, Brugaletta, Salvatore, Alegria-Barrero, Eduardo, Meuwissen, Martijin, Piek, Jan J., van Royen, Niels, Sezer, Murat, Di Mario, Carlo, Gerber, Robert T., Malik, Iqbal S., Sharp, Andrew S.P., Talwar, Suneel, Tang, Kare, Samady, Habib, Altman, John, Seto, Arnold H., Singh, Jasvindar, Jeremias, Allen, Matsuo, Hitoshi, Kharbanda, Rajesh K., Patel, Manesh R., Serruys, Patrick, Escaned, Javier·2017·New England Journal of Medicine

Abstract

BACKGROUND: Coronary revascularization guided by fractional flow reserve (FFR) is associated with better patient outcomes after the procedure than revascularization guided by angiography alone. It is unknown whether the instantaneous wave-free ratio (iFR), an alternative measure that does not require the administration of adenosine, will offer benefits similar to those of FFR. METHODS: We randomly assigned 2492 patients with coronary artery disease, in a 1:1 ratio, to undergo either iFR-guided or FFR-guided coronary revascularization. The primary end point was the 1-year risk of major adverse cardiac events, which were a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization. The trial was designed to show the noninferiority of iFR to FFR, with a margin of 3.4 percentage points for the difference in risk. RESULTS: At 1 year, the primary end point had occurred in 78 of 1148 patients (6.8%) in the iFR group and in 83 of 1182 patients (7.0%) in the FFR group (difference in risk, -0.2 percentage points; 95% confidence interval [CI], -2.3 to 1.8; P<0.001 for noninferiority; hazard ratio, 0.95; 95% CI, 0.68 to 1.33; P=0.78). The risk of each component of the primary end point and of death from cardiovascular or noncardiovascular causes did not differ significantly between the groups. The number of patients who had adverse procedural symptoms and clinical signs was significantly lower in the iFR group than in the FFR group (39 patients [3.1%] vs. 385 patients [30.8%], P<0.001), and the median procedural time was significantly shorter (40.5 minutes vs. 45.0 minutes, P=0.001). CONCLUSIONS: Coronary revascularization guided by iFR was noninferior to revascularization guided by FFR with respect to the risk of major adverse cardiac events at 1 year. The rate of adverse procedural signs and symptoms was lower and the procedural time was shorter with iFR than with FFR. (Funded by Philips Volcano; DEFINE-FLAIR ClinicalTrials.gov number, NCT02053038 .).

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Authors
Davies, J. E., Sen, S., Dehbi, H.-M., Al-Lamee, R., Petraco, R., Nijjer, S. S., Bhindi, R., Lehman, S. J., Walters, D., Sapontis, J., Janssens, L., Vrints, C. J., Khashaba, A., Laine, M., Van Belle, E., Krackhardt, F., Bojara, W., Going, O., Härle, T., Indolfi, C., Niccoli, G., Ribichini, F., Tanaka, N., Yokoi, H., Takashima, H., Kikuta, Y., Erglis, A., Vinhas, H., Canas Silva, P., Baptista, S. B., Alghamdi, A., Hellig, F., Koo, B.-K., Nam, C.-W., Shin, E.-S., Doh, J.-H., Brugaletta, S., Alegria-Barrero, E., Meuwissen, M., Piek, J. J., van Royen, N., Sezer, M., Di Mario, C., Gerber, R. T., Malik, I. S., Sharp, A. S. P., Talwar, S., Tang, K., Samady, H., Altman, J., Seto, A. H., Singh, J., Jeremias, A., Matsuo, H., Kharbanda, R. K., Patel, M. R., Serruys, P., & Escaned, J.
Venue
New England Journal of Medicine
Published
2017-05-11
Volume
376
Issue
19
Pages
1824-1834
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2597278873
Cited by
979
References
2
FWCI
109.16
Type
journal article
Language
en
Open access
bronze

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CoChat. (2026). Citation check: Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI. https://app.cochat.ai/papers/10.1056/nejmoa1700445
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Davies, J. E., Sen, S., Dehbi, H.-M., Al-Lamee, R., Petraco, R., Nijjer, S. S., Bhindi, R., Lehman, S. J., Walters, D., Sapontis, J., Janssens, L., Vrints, C. J., Khashaba, A., Laine, M., Van Belle, E., Krackhardt, F., Bojara, W., Going, O., Härle, T., . . . Escaned, J. (2017). Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI. New England Journal of Medicine. https://doi.org/10.1056/nejmoa1700445

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