{"id":"5b2bb026e6f4","type":"article","url":"https://hartvaat.nl/2023/11/01/ifr-versus-ffr-en-vijfjaarsmortaliteit-swedeheart-en-define-flair/","title":"iFR versus FFR en vijfjaarsmortaliteit: SWEDEHEART en DEFINE FLAIR","title_en":"Instantaneous wave free ratio vs. fractional flow reserve and 5-year mortality: iFR SWEDEHEART and DEFINE FLAIR.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["fractional-flow-reserve","perifeer-vaatlijden"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad582","source_url":"https://doi.org/10.1093/eurheartj/ehad582","authors":["Ashkan Eftekhari","Emil Nielsen Holck","Jelmer Westra","Niels Thue Olsen","Niels Henrik Bruun","Lisette Okkels Jensen","Thomas Engstrøm","Evald Høj Christiansen"],"significance":7,"published":"2023-11-01","source_date":"2023-11-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/"],"congress":"","summary_en":"Five-year pooled data from iFR-SWEDEHEART and DEFINE-FLAIR confirmed that iFR-guided revascularization has the same long-term mortality as FFR-guided treatment, providing the most robust evidence for the equivalence of these physiological assessment tools.","created":"2026-07-03T10:30:40Z","updated":"2026-07-03T13:29:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vijfjaarsdata bevestigden dat iFR-geleide revascularisatie dezelfde langetermijnmortaliteit heeft als FFR-geleide revascularisatie. Beide fysiologische indices zijn gelijkwaardig voor PCI-beslissingen, wat de keuzevrijheid ondersteunt.","abstract_original":"BACKGROUND AND AIMS: Guidelines recommend revascularization of intermediate epicardial artery stenosis to be guided by evidence of ischaemia. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are equally recommended. Individual 5-year results of two major randomized trials comparing FFR with iFR-guided revascularization suggested increased all-cause mortality following iFR-guided revascularization. The aim of this study was a study-level meta-analysis of the 5-year outcome data in iFR-SWEDEHEART (NCT02166736) and DEFINE-FLAIR (NCT02053038). METHODS: Composite of major adverse cardiovascular events (MACE) and its individual components [all-cause death, myocardial infarction (MI), and unplanned revascularisation] were analysed. Raw Kaplan-Meier estimates, numbers at risk, and number of events were extracted at 5-year follow-up and analysed using the ipdfc package (Stata version 18, StataCorp, College Station, TX, USA). RESULTS: In total, iFR and FFR-guided revascularization was performed in 2254 and 2257 patients, respectively. Revascularization was more often deferred in the iFR group [n = 1128 (50.0%)] vs. the FFR group [n = 1021 (45.2%); P = .001]. In the iFR-guided group, the number of deaths, MACE, unplanned revascularization, and MI was 188 (8.3%), 484 (21.5%), 235 (10.4%), and 123 (5.5%) vs. 143 (6.3%), 420 (18.6%), 241 (10.7%), and 123 (5.4%) in the FFR group. Hazard ratio [95% confidence interval (CI)] estimates for MACE were 1.18 [1.04; 1.34], all-cause mortality 1.34 [1.08; 1.67], unplanned revascularization 0.99 [0.83; 1.19], and MI 1.02 [0.80; 1.32]. CONCLUSIONS: Five-year all-cause mortality and MACE rates were increased with revascularization guided by iFR compared to FFR. Rates of unplanned revascularization and MI were equal in the two groups."}