Li Kam Wa Matthew E, Ezad Saad M, Modi Bhavik, Demir Ozan M, Hinton Jonathan, Ellis Howard, De Silva Kalpa, Gulati Ankur, De Silva Ranil, O'Kane Peter, Douiri Abdel, Collison Damien, Curzen Nick, Collet Carlos, Perera Divaka
British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom.
Glenfield Hospital, University Hospitals of Leicester NHS Trust & University of Leicester, NIHR Leicester Biomedical Research, Leicester, United Kingdom.
JACC Cardiovasc Interv. 2025 Jul 14;18(13):1617-1627. doi: 10.1016/j.jcin.2025.05.033.
Fractional flow reserve (FFR) and the instantaneous wave-free ratio (iFR) identify arteries that benefit from percutaneous coronary intervention (PCI). FFR or iFR gradients on pullback are often used to predict the physiological result (FFR or iFR), but this approach is unvalidated.
The aim of this study was to compare the accuracy of FFR, iFR and FFR (a mathematical solution incorporating interaction between lesions) for predicting post-PCI physiology in serial or diffuse disease.
Patients with a focal target lesion and either a second focal lesion or a diffusely diseased segment in the same vessel were randomized to FFR- vs iFR-guided PCI (ISRCTN18106869). FFR and iFR pullbacks were performed, with operators blinded to one modality. Following target lesion PCI, FFR and iFR were remeasured. The primary outcome was the error in predicted post-PCI physiology compared with actual values.
A total of 87 patients were randomized to FFR (n = 45) or iFR (n = 42). Median FFR and iFR were 0.70 (Q1-Q3: 0.62 to 0.78) and 0.81 (Q1-Q3: 0.68 to 0.90) at baseline and 0.82 (Q1-Q3: 0.74 to 0.87) and 0.89 (Q1-Q3: 0.83 to 0.93) after target lesion PCI. The predictive errors were 12% (6% to 17%) for FFR, 4% (0% to 9%; P < 0.001) for iFR, and -5% (-18% to 8%; P = 0.427) for FFR. Significant residual disease was missed in 36% of cases with FFR, 34% with iFR, and 14% with FFR.
FFR and iFR pullback gradients overestimate the benefit of target lesion PCI and can miss residual ischemia in one-third of patients. FFR or iFR should be routinely repeated post-PCI in serial disease.
血流储备分数(FFR)和瞬时无波比值(iFR)可识别能从经皮冠状动脉介入治疗(PCI)中获益的动脉。回撤时的FFR或iFR梯度常被用于预测生理结果(FFR或iFR),但这种方法未经证实。
本研究旨在比较FFR、iFR和FFR(一种纳入病变间相互作用的数学解决方案)在预测串联或弥漫性疾病PCI术后生理情况时的准确性。
同一血管中有一个局灶性靶病变以及另一个局灶性病变或弥漫性病变节段的患者被随机分为FFR引导的PCI组和iFR引导的PCI组(国际标准随机对照试验编号:ISRCTN18106869)。进行FFR和iFR回撤操作,操作者对其中一种方法不知情。在靶病变PCI术后,重新测量FFR和iFR。主要结局是预测的PCI术后生理情况与实际值相比的误差。
共有87例患者被随机分为FFR组(n = 45)或iFR组(n = 42)。基线时FFR和iFR的中位数分别为0.70(四分位间距:0.62至0.78)和0.81(四分位间距:0.68至0.90),靶病变PCI术后分别为0.82(四分位间距:0.74至0.87)和0.89(四分位间距:0.83至0.93)。FFR的预测误差为12%(6%至17%),iFR为4%(0%至9%;P < 0.001),FFR为-5%(-18%至8%;P = 0.427)。36%的FFR病例、34%的iFR病例和14%的FFR病例遗漏了显著的残余病变。
FFR和iFR回撤梯度高估了靶病变PCI的获益,并且会遗漏三分之一患者的残余缺血情况。对于串联病变,PCI术后应常规重复测量FFR或iFR。