- Question
- Is coronary revascularization guided by the instantaneous wave-free ratio (iFR), which does not require adenosine, noninferior to guidance by fractional flow reserve (FFR)?
- Design
- Randomized 1:1 noninferiority trial, double-blind per the registry, enrolling 2492 patients with coronary artery disease. The noninferiority margin was 3.4 percentage points for the difference in risk.
- Population
- Patients with coronary artery disease undergoing assessment for revascularization, with intermediate-severity stenoses.
- Intervention
- Coronary revascularization guided by iFR.
- Control
- Coronary revascularization guided by FFR.
- Primary outcome
- Major adverse cardiac events at 1 year: a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization.
- Results
- The primary endpoint occurred in 78 of 1148 patients (6.8%) in the iFR group and in 83 of 1182 (7.0%) in the FFR group (risk difference -0.2 percentage points; 95% CI -2.3 to 1.8; P<0.001 for noninferiority; HR 0.95; 95% CI 0.68 to 1.33). Adverse procedural symptoms and signs were less frequent with iFR (3.1% vs. 30.8%, P<0.001).
- Safety
- There were no significant differences between groups in each component of the primary endpoint or in cardiovascular or noncardiovascular death. Adverse procedural symptoms and signs were less frequent with iFR, and median procedural time was shorter (40.5 vs. 45.0 minutes, P=0.001).
- Conclusion
- iFR-guided revascularization was noninferior to FFR-guided revascularization for major adverse cardiac events at 1 year, with fewer procedural adverse effects and shorter procedure time.
- Why it matters
- It showed that a physiological measure that does not require adenosine can replace FFR in deciding on revascularization with similar clinical outcomes and a more tolerable procedure.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026