Coronary disease & ACSRandomised controlled trial
Randomized Comparison of Fractional Flow Reserve and Instantaneous Wave Free Ratio in Serial Disease
- Randomised controlled trial
- operators blinded to one modality
Authors' conclusion
FFR and iFR pullback gradients overestimate the benefit of target lesion PCI and can miss residual ischemia in one-third of patients.
Study context
- Population
- Patients with a focal target lesion and a second focal lesion or diffusely diseased segment in the same vessel (serial or diffuse disease)
- Participants
- 87 patients
- Comparison
- Fractional flow reserve (FFR) vs iFR
- FFRn = 45
- iFRn = 42
- Primary endpoint
- Error in predicted post-PCI physiology vs actual values
- Follow-up
- After target lesion PCI
Primary result
As reported in the abstract
Predictive error of post-PCI physiology
Predictive error, FFRΔ
12% (6% to 17%)
Predictive error, iFRΔ
4% (0% to 9%; P < 0.001)
Predictive error, FFRcalc
−5% (−18% to 8%; P = 0.427)
Further findings
Significant residual disease missed
- Missed with FFRΔ
- 36%
- Missed with iFRΔ
- 34%
- Missed with FFRcalc
- 14%
FFR and iFR at baseline and after target lesion percutaneous coronary intervention (PCI)
- Median FFR at baseline
- 0.70 (Q1-Q3: 0.62 to 0.78)
- Median iFR at baseline
- 0.81 (Q1-Q3: 0.68 to 0.90)
- Median FFR after target lesion PCI
- 0.82 (Q1-Q3: 0.74 to 0.87)
- Median iFR after target lesion PCI
- 0.89 (Q1-Q3: 0.83 to 0.93)
Original publication
Randomized Comparison of Fractional Flow Reserve and Instantaneous Wave Free Ratio in Serial Disease. JACC Cardiovasc Interv. Published 14 July 2025. doi:10.1016/j.jcin.2025.05.033
Summarised from the published abstract; every number is checked against it