Coronary Revascularization Guided With Fractional Flow Reserve or Instantaneous Wave-Free Ratio: A 5-Year Follow-Up of the DEFINE FLAIR Randomized Clinical Trial
Primary result · MACEResult — go to the resultHazard ratio 1.18 95% CI 0.99–1.42Authors' conclusion
At 5-year follow up, an iFR based-strategy was not statistically different than an FFR strategy to guide revascularization in terms of MACE, nonfatal myocardial infarction, and unplanned revascularization.
Study context
- Population
- Patients from 5 continents with CAD and angiographically intermediate severity stenoses undergoing pressure-wire interrogation
- Comparison
- iFR-guided vs fractional flow reserve (FFR)-guided revascularization
- Primary endpoint
- Major adverse cardiac events (MACE):
- All-cause death
- Nonfatal MI
- Unplanned revascularization
- Follow-up
- 5 years
Methodological detailsmulticentre
- Multicentre
Primary result
MACE
Hazard ratio
1.18
95% CI 0.99–1.42
P = 0.06
By group
iFR vs FFR
HR 1.18 (95% CI 0.99–1.42); P = 0.06
As reported in the abstract
Further findings
| Outcome | iFR | FFR | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| Nonfatal MI · 5 years | 6.3% | 6.2% | 1.01 (0.74–1.38) | P = 0.94 | |
| Unplanned revascularization · 5 years | 11.9% | 12.2% | 0.98 (0.78–1.23) | P = 0.87 | |
| MACE, deferred revascularization (subgroup) · 5 years | 17.9% | 17.5% | 1.03 (0.79–1.35) | P = 0.80 | |
| MACE, revascularized after physiologic interrogation (subgroup) · 5 years | 24.6% | 19.2% | 1.36 (1.07–1.72) | P = 0.01 | |
| 0.512Hazard ratio (log scale) |
All-cause death · 5 years
- All-cause death higher among patients randomized to iFR
Original publication
Coronary Revascularization Guided With Fractional Flow Reserve or Instantaneous Wave-Free Ratio: A 5-Year Follow-Up of the DEFINE FLAIR Randomized Clinical Trial. JAMA Cardiol. Published 1 January 2025. doi:10.
Summarised from the published abstract; every number is checked against it