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Trends in physiology and Correlation Between iFR and FFR in Coronary Physiological Assessment: A Decade of Real-World Data
Session:
SESSÃO DE POSTERS 40 - INTERVENÇÃO CORONÁRIA
Speaker:
Marta Vilela
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.3 Coronary Artery Disease – Diagnostic Methods
Session Type:
Cartazes
FP Number:
---
Authors:
Marta Miguez Vilela; Miguel Nobre Menezes; Diogo Ferreira; Claudia Jorge; João Marques; Pedro Carrilho; Tiago Rodrigues; Ana Rita Francisco; Pedro Cardoso; Fausto Pinto
Abstract
<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Arial,sans-serif"><strong>Introduction:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Arial,sans-serif">Coronary artery disease (CAD) treatment often relies on coronary angiography, but coronary physiological assessment, including Fractional Flow Reserve (FFR) and Instantaneous Wave-Free Ratio (iFR), provides a more accurate evaluation of coronary stenosis severity. While FFR has long been the gold standard for guiding revascularization, iFR has gained attention for its ability to deliver similar clinical outcomes with a simpler resting approach. This study evaluates trends in the use of iFR versus FFR, as well as changes in procedure times, radiation exposure, and the correlation between iFR and FFR over the past decade.</span></span></p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Arial,sans-serif"><strong>Methods:</strong><br /> This retrospective, single-center study included patients who underwent coronary physiological assessment between 2012 and 2022. The population was divided into two groups based on the timing of catheterization: the "past group" (2012–2015) and the "present group" (2020–2022). Differences between the groups were evaluated using chi-square, independent t-test, or Mann-Whitney U test. Bland-Altman analysis and Pearson correlation were used to compare iFR and FFR values.</span></span></p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Arial,sans-serif"><strong>Results:</strong><br /> A total of 660 patients were included, with 263 in the past group and 397 in the present group.</span></span></p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Arial,sans-serif">Both groups were similar in age, gender, and comorbidities. Procedure time (73.9 ± 21 vs. 63.8 ± 28 minutes, <em>p</em>=0.004) and radiation exposure (10.5 ± 4 vs. 6.4 ± 3 Gy, <em>p</em> < 0.001) were significantly higher in the past group. The left anterior descending artery was the most commonly assessed vessel, followed by the right coronary artery.</span></span></p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Arial,sans-serif">In the past group, the majority of patients (60%) underwent FFR-only procedures, with 33% receiving a combination of FFR and iFR assessments. In contrast, in the present group, 91% of procedures were iFR-only. FFR was utilized in 8% of cases, and in 77% of those instances, it involved the left anterior descending artery. For iFR-only assessments, the mean iFR value was 0.87 ± 0.12, while for FFR-only assessments, the mean FFR value was 0.80 ± 0.12. A total of 41 patients underwent combined procedures, with iFR and FFR values close to their cutoff points (iFR: 0.90 ± 0.04, FFR: 0.81 ± 0.07). A significant correlation was observed between iFR and FFR values (R = 0.38; <em>p</em> < 0.001), with good agreement by Bland-Altman analysis (mean difference between iFR and FFR: 0.056 ± 0.05).</span></span></p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Arial,sans-serif"><strong>Conclusion:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:"Arial",sans-serif">This study shows a growing preference for iFR, associated with shorter procedure times and lower radiation exposure. A significant correlation between iFR and FFR was observed, with both methods showing good agreement.</span></span></p>
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