Long-Term Study Reveals Comparable Outcomes for iFR and FFR in Coronary Revascularization: DEFINE FLAIR Trial

Spain: A recent 5-year follow-up of the DEFINE FLAIR randomized clinical trial has provided new insights into the effectiveness of coronary revascularization strategies guided by either fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR).
The DEFINE FLAIR trial initially compared the two approaches in a cohort of patients undergoing revascularization. At the 5-year mark, the study, published in JAMA Cardiology, revealed that an iFR-based strategy was not statistically different from an FFR-based approach in guiding revascularization regarding major adverse cardiovascular events (MACE), nonfatal myocardial infarction, and unplanned revascularization.
Javier Escaned, Hospital Clinico San Carlos IDISSC, Complutense University of Madrid and CIBERCV, Madrid, Spain, and colleagues aimed to compare the long-term outcomes of iFR- and FFR-based strategies for guiding revascularization, noting that the long-term differences between these two approaches remain unclear.
The DEFINE-FLAIR multicenter study randomized patients with coronary artery disease to utilize either iFR or FFR as a pressure index to guide revascularization. Participants were drawn from five continents and had angiographically intermediate severity stenoses, undergoing hemodynamic interrogation with pressure wires. Data for this analysis were collected from March 13, 2014, to April 27, 2021.
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