Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve-Guided Revascularization Strategy

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Kim , C H , Koo , B-K , Dehbi , H-M , Lee , J M , Doh , J-H , Nam , C-W , Shin , E-S , Cook , C M , Al-Lamee , R , Petraco , R , Sen , S , Malik , I S , Nijjer , S S , Mejia-Renteria , H , Alegria-Barrero , E , Alghamdi , A , Altman , J , Baptista , S B , Bhindi , R , Bojara , W , Brugaletta , S , Silva , P C , Di Mario , C , Erglis , A , Gerber , R T , Going , O , Haerle , T , Hellig , F , Indolfi , C , Janssens , L , Jeremias , A , Kharbanda , R K , Khashaba , A , Kikuta , Y , Krackhardt , F , Laine , M , Lehman , S J , Matsuo , H , Meuwissen , M , Niccoli , G , Piek , J J , Ribichini , F , Samady , H , Sapontis , J , Seto , A H , Sezer , M , Sharp , A S P , Singh , J , Takashima , H , Talwar , S , Tanaka , N , Tang , K , Van Belle , E , van Royen , N , Vinhas , H , Vrints , C J , Walters , D , Yokoi , H , Samuels , B , Buller , C , Patel , M R , Serruys , P W , Escaned , J & Davies , J E 2019 , ' Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve-Guided Revascularization Strategy ' , JACC: Cardiovascular Interventions , vol. 12 , no. 20 , pp. 2035-2046 . https://doi.org/10.1016/j.jcin.2019.06.035

Title: Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve-Guided Revascularization Strategy
Author: Kim, Chee Hae; Koo, Bon-Kwon; Dehbi, Hakim-Moulay; Lee, Joo Myung; Doh, Joon-Hyung; Nam, Chang-Wook; Shin, Eun-Seok; Cook, Christopher M.; Al-Lamee, Rasha; Petraco, Ricardo; Sen, Sayan; Malik, Iqbal S.; Nijjer, Sukhjinder S.; Mejia-Renteria, Hernan; Alegria-Barrero, Eduardo; Alghamdi, Ali; Altman, John; Baptista, Sergio B.; Bhindi, Ravinay; Bojara, Waldemar; Brugaletta, Salvatore; Silva, Pedro Canas; Di Mario, Carlo; Erglis, Andrejs; Gerber, Robert T.; Going, Olaf; Haerle, Tobias; Hellig, Farrel; Indolfi, Ciro; Janssens, Luc; Jeremias, Allen; Kharbanda, Rajesh K.; Khashaba, Ahmed; Kikuta, Yuetsu; Krackhardt, Florian; Laine, Mika; Lehman, Sam J.; Matsuo, Hitoshi; Meuwissen, Martijin; Niccoli, Giampaolo; Piek, Jan J.; Ribichini, Flavo; Samady, Habib; Sapontis, James; Seto, Arnold H.; Sezer, Murat; Sharp, Andrew S. P.; Singh, Jasvindar; Takashima, Hiroaki; Talwar, Suneel; Tanaka, Nobuhiro; Tang, Kare; Van Belle, Eric; van Royen, Niels; Vinhas, Hugo; Vrints, Christiaan J.; Walters, Darren; Yokoi, Hiroyoshi; Samuels, Bruce; Buller, Christopher; Patel, Manesh R.; Serruys, Patrick W.; Escaned, Javier; Davies, Justin E.
Contributor: University of Helsinki, HUS Heart and Lung Center
Date: 2019-10-28
Language: eng
Number of pages: 12
Belongs to series: JACC: Cardiovascular Interventions
ISSN: 1936-8798
URI: http://hdl.handle.net/10138/322077
Abstract: OBJECTIVES This study sought to evaluate sex differences in procedural characteristics and clinical outcomes of instantaneous wave-free ratio (iFR)- and fractional flow reserve (FFR)-guided revascularization strategies. BACKGROUND An iFR-guided strategy has shown a lower revascularization rate than an FFR-guided strategy, without differences in clinical outcomes. METHODS This is a post hoc analysis of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate stenosis to guide Revascularization) study, in which 601 women and 1,891 men were randomized to iFR- or FFR-guided strategy. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. RESULTS Among the entire population, women had a lower number of functionally significant lesions per patient (0.31 +/- 0.51 vs. 0.43 +/- 0.59; p <0.001) and less frequently underwent revascularization than men (42.1% vs. 53.1%; p <0.001). There was no difference in mean iFR value according to sex (0.91 +/- 0.09 vs. 0.91 +/- 0.10; p = 0.442). However, the mean FFR value was lower in men than in women (0.83 +/- 0.09 vs. 0.85 +/- 0.10; p = 0.001). In men, an FFR-guided strategy was associated with a higher rate of revascularization than an iFR-guided strategy (57.1% vs. 49.3%; p = 0.001), but this difference was not observed in women (41.4% vs. 42.6%; p = 0.757). There was no difference in MACE rates between iFR- and FFR-guided strategies in both women (5.4% vs. 5.6%, adjusted hazard ratio: 1.10; 95% confidence interval: 0.50 to 2.43; p = 0.805) and men (6.6% vs. 7.0%, adjusted hazard ratio: 0.98; 95% confidence interval: 0.66 to 1.46; p = 0.919). CONCLUSIONS An FFR-guided strategy was associated with a higher rate of revascularization than iFR-guided strategy in men, but not in women. However, iFR- and FFR-guided strategies showed comparable clinical outcomes, regardless of sex. (C) 2019 by the American College of Cardiology Foundation.
Subject: clinical outcome
fractional flow reserve
instantaneous wave-free ratio
sex
PERCUTANEOUS CORONARY INTERVENTION
MICROVASCULAR DYSFUNCTION
ARTERY-DISEASE
STENOSIS
ANGIOGRAPHY
ASSOCIATION
GUIDELINES
SEVERITY
PRESSURE
INDEXES
3121 General medicine, internal medicine and other clinical medicine
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