Instantaneous wave‐free ratio for guiding treatment of nonculprit lesions in patients with acute coronary syndrome: A retrospective study

Abstract

Background The aim of this study was to analyze the feasibility of a physiological coronary evaluation with the instantaneous wave‐free ratio (iFR) of nonculprit lesions in patients with acute coronary syndrome (ACS) successfully revascularized. Methods A multicenter registry including patients of four high‐volume PCI centers with ACS and underwent successful revascularization of the culprit vessel and had other nonculprit lesions that were physiologically evaluated with the iFR between January 2017 and December 2019. The primary endpoint was a composite of cardiac death, nonfatal myocardial infarction, probable or definitive stent thrombosis and new revascularization (MACEs). Results A total of 356 patients with 472 nonculprit lesions were included. The mean age was 66 ± 11 years. The clinical presentation was ACS without persistent ST‐segment elevation (NSTE‐ACS) in 235 patients (66%) and ST‐segment elevation myocardial infarction (STEMI) in 121 patients (34%). After a median follow‐up period of 21 (14‐30) months, the primary endpoint occurred in 32 patients (9%). There were no differences in outcomes regarding clinical presentation (NSTEMI vs. NSTE‐ACS, 9.1 vs. 8.9%, padj = 0.570) or iFR induced treatment strategy (patients with all lesions revascularized vs. patients with at least one lesion with an iFR > 0.89 deferred for revascularization, 10.5 vs. 8.4%, padj = 0.476). Conclusions The use of the iFR to guide percutaneous coronary intervention decision making in nonculprit lesions seems to be feasible, with an acceptable percentage of MACEs at the mid‐term follow‐up. Patients with deferred revascularization of lesions without physiological significance and patients undergoing complete revascularization had a similar risk of MACEs.

Coronary Physiology: Modern Concepts for the Guidance of Percutaneous Coronary Interventions and Medical Therapy

“…Indeed, only around 15% of the patients had ACS at presentation in the main iFR trials; however, iFR results led to similar outcomes, regardless of clinical presentation [ 38 ], and similar results were also confirmed in large scale registries [ 39 ].…”

Fractional flow reserve and non-hyperemic indices: Essential tools for percutaneous coronary interventions

“…Following the validation studies described above, NHPR share similar indications than FFR but additional specific clinical scenario’s have been investigated. For example, a retrospective study reported how to decide to perform a PCI with iFR in non-culprit lesions of patients presenting with ACS[ 74 ].…”

The value of intravascular ultrasound in patients with acute myocardial infarction

“…Placing a stent on all coronary lesions seen on coronary angiogram without certifying the impact of these lesions can complicate the procedure and jeopardize the outcome of the patient. There are a lot of data showing that PCI guidance by invasive imagistic and physiological investigation methods improves the outcome of the patient, with clear cut-offs for assessments that can guide us to achieve the best result with an adequate percentage of MACEs at the mid-term follow-up [8].…”