Adverse cardiac events compared between instantaneous wave-free ratio-guided and standard angiography-guided revascularization in thai patients with intermediate-grade stenosis coronary artery disease

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND | 2019. Objective: To compare the rate of adverse cardiac events between instantaneous wave-free ratio (iFR)-guided and standard angiography-guided revascularization in Thai patients with intermediate coronary artery disease (CAD). Materials and Methods: This retrospective cohort clinical study included patients with intermediate CAD who underwent revascularization at Siriraj Hospital, Thailand’s largest national tertiary referral center, between January 2016 and June 2017. Enrolled patients underwent either iFR-guided or standard angiography-guided revascularization. Baseline demographic and clinical data, laboratory investigations, medications, intraprocedural findings, postprocedural outcomes, composite endpoint of death from any cause, non-fatal myocardial infarction, and repeat revascularization were compared between groups. Results: Three hundred forty-three patients (98 iFR-guided, 245 angiography-guided) were included. The mean age was 67 years, and 218 were male. A primary endpoint event occurred in five patients in the iFR group, and in 21 patients in the angiography group. The rate of death from any cause, non-fatal myocardial infarction, repeat revascularization, and stent thrombosis did not differ significantly between groups, but each rate was lower in the iFR group. Fluoroscopic time, radiation dose, and procedure cost were all significantly lower in the iFR group. Conclusion: For the patients with intermediate stenosis of CAD, the iFR guided treatment group had a trend toward lower rate of a composite of death, non-fatal myocardial infarction, and repeat revascularization than angiography guided group, but not statistically significant.