Work

Clinical Outcomes Following Discordance Between Fractional Flow Reserve and Instantaneous Wave-Free Ratio in Deferred Coronary Lesions: A Systematic Review and Meta-Analysis

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background: Current guidelines recommend the use of either fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) for assessing intermediate coronary stenoses. However, FFR/iFR discordance occurs in approximately 20% of cases. This systematic review and meta-analysis aimed to investigate whether deferring lesions with discordant FFR/iFR classification is associated with worse prognosis compared to those with negative concordant results (FFR–/iFR–). Methods: A systematic search was conducted in literature repositories to identify all studies that compared the clinical prognosis of deferred lesions with discordant and concordant FFR/iFR results. The primary endpoint was a composite clinical outcome of the individual secondary endpoints (death, myocardial infarction, and revascularization). Results: Three eligible observational studies (1735 deferred vessels) were included in the meta-analysis. Overall, deferred lesions with FFR/iFR discordance presented numerically higher event rates for all primary and secondary endpoints compared to deferred lesions with negative concordance; however, none reached statistical significance. Deferred lesions with FFR–/iFR+ discordance were significantly associated with an increased risk of death (odds ratio [OR]: 3.19; p = 0.049), while deferred lesions with FFR+/iFR– discordance were associated with a greater risk of revascularization compared to deferred lesions with negative concordance (OR: 3.24; p = 0.01). Conclusions: Compared to deferred lesions with negative concordant results, deferred lesions with discordant FFR/iFR results were overall not significantly associated with worse clinical outcomes; however, there was a significantly greater risk of death for deferred lesions specifically with FFR–/iFR+ discordance, and an increased risk of revascularization for deferred lesions with FFR+/iFR– discordance. Further dedicated trials are needed to improve guidance in clinical decision-making. The PROSPERO Registration: CRD420251135424, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251135424.

Source: Reviews in Cardiovascular Medicine

DOI: 10.31083/rcm44868