EuroPCR 2017: Pooled analysis of DEFINE-FLAIR and IFR SWEDEHEART: safety of iFR- and FFR-based deferral may not be the same in stable and unstable patients

Reported from EuroPCR 2017, Paris

In the light of contemporary debates surrounding the issue of non-culprit lesions in ACS patients, discriminating between patients who need revascularization, and those who could be safely deferred, may be of considerable clinical importance.

The main objective of this pooled analysis was to compare the safety of deferring PCI in ACS patients, based on FFR vs. iFR measurements in non-culprit vessels. In the overall population, consisting of 2130 patients, pooled from the deferred groups (FFR > 0.80 or iFR >0.89) of DEFINE-FLAIR and IFR-SWEDEHEART trials, FFR and iFR were equally safe in deferring PCI. However, ACS patients with deferred revascularization of non-culprit lesions had higher rate of MACE at one year, compared to deferred stable angina patients.

While FFR-based deferral was associated with a higher MACE rate, in ACS compared to stable angina patients, no statistically significant difference between ACS and stable patients was seen in patients with iFR-based deferring of PCI.

One-year outcomes after deferral of myocardial revascularization based on FFR and iFR measurements seem to be favorable, albeit caution may have to be taken when evaluating non-culprit stenoses in ACS patients due to a greater risk of MACE in ACS patients with deferred revascularization of non-culprit stenosis, as compared with deferred stable angina patients.

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