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iFR, the new gold standard? DEFINE-FLAIR and iFR-SWEDEHEART

Two important trials have officially opened the evidence-based era of iFR.

Reported from the American College of Cardiology 2017 Scientific Sessions in Washington.

Taken together, DEFINE-FLAIR and iFR-SWEDEHEART randomized >4000 patients, which is good news for both iFR and FFR proponents. The two trials share many characteristics, including similar hypotheses (iFR being noninferior to FFR), sample size, endpoints and – very consistently - clinical outcomes.

Results point to noninferiority of iFR

The results clearly point towards the noninferiority of iFR, which has the advantage of being more tolerated by patients due to avoidance of adenosine administration. With a cut-off of 0.89 and no “gray zone”, the results of the trial can be theoretically implemented in our next patient presenting with intermediate coronary lesions. It is difficult at this point not to imagine iFR to enter the next guidelines for myocardial revascularization with a class I recommendation, which obviously does not mean FFR to disappear.

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