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Temporal trends in physiology coronary indexes and their impact on revascularization
Session:
Painel 11 - Cardiologia Intervenção 4
Speaker:
Pedro Silvério António
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.1 Invasive Imaging and Functional Assessment
Session Type:
Posters
FP Number:
---
Authors:
Pedro Silvério António; Miguel Nobre Menezes; Ana Rita Francisco; Pedro Pinto Cardoso; E. Infante de Oliveira; Diogo Torres; Inês Aguiar Ricardo; Pedro Morais; Nelson P. Cunha; Beatriz Silva; Pedro Alves Da Silva; Fausto José Pinto; Pedro Canas Da Silva
Abstract
<p>Introduction: Physiological measurements obtained during invasive procedures remain one of the most important diagnostic techniques available in the cathlab. FFR was the only technique widely available and validated for several years. iFR was introduced later and its non-inferiority to FFR established in 2017 with the publication of the DEFINE FLAIR and iFR SWEDEHEART trials. However, these trials suggested that the use of iFR is associated with fewer revascularization procedures when compared to FFR.</p> <p><br /> Purpose: to evaluate the experience with FFR or iFR at a high-volume center and assess their impact on revascularization decisions.</p> <p><br /> Methods: prospective single center study of patients submitted to functional lesion assessment with iFR or FFR between 2012 and 2019. Demographic, clinical and procedural characteristics were collected. For statistical analysis of association, we used T-tests (quantitative variables) and chi-square test (qualitative variables). For the purpose of assessing the specific impact of iFR or FFR on decisions, only cases in which one of the indexes were measured were analysed (i.e. hybrid strategy cases were excluded). The threshold for revascularization in these cases was an iFR ≤ 0,89 or FFR ≤ 0,80.</p> <p><br /> Results: Measurements using only FFR or iFR were performed in 710 lesions (585 patients, mean age 67±11 years, 70% men).</p> <p>iFR was performed in 451 lesions (63,5%) and FFR in 259 lesions (36,5%). Revascularization was performed in 258 cases (36,3%) – 226 (31,8%) with PCI and 32 (4,5%) with CABG; 452 (63,7%) patients were kept on medical therapy only.</p> <p>In those cases where the lesions were assessed by iFR, the decision of revascularization was lower when compared with those assessed by FFR (32,2 % vs 43,6%) - this difference was highly significant (p= 0,002).</p> <p>In patients undergoing PCI, there was no difference with regards to the number or total length of stents used between the iFR-only and FFR-only groups.</p> <p>Conclusion: In our center, the incidence of revascularization in lesions submitted to physiological assessment was higher in patients assessed with FFR-only when compared with those assessed with iFR-only. This is in accordance with published data. The wide adoption of iFR-only as a coronary physiological assessment strategy may therefore lead to fewer revascularizations.</p>
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