- Question
- Is an iFR (instantaneous wave-free ratio)-guided revascularization strategy noninferior to an FFR (fractional flow reserve)-guided strategy with respect to major adverse cardiac events?
- Design
- Multicenter, randomized, controlled, open-label trial that used the Swedish Coronary Angiography and Angioplasty Registry (SWEDEHEART) as its enrollment platform. A total of 2037 participants were randomized, and the aim was to show noninferiority at 12 months.
- Population
- Patients with stable angina or an acute coronary syndrome who had an indication for physiologically guided assessment of coronary-artery stenosis.
- Intervention
- Revascularization guided by iFR.
- Control
- Revascularization guided by FFR.
- Primary outcome
- Composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization within 12 months after the procedure.
- Results
- A primary end-point event occurred in 68 of 1012 patients (6.7%) in the iFR group and in 61 of 1007 (6.1%) in the FFR group (difference 0.7 percentage points; 95% CI, -1.5 to 2.8; P=0.007 for noninferiority; HR 1.12; 95% CI, 0.79 to 1.58). Results were similar across major subgroups.
- Safety
- Rates of myocardial infarction, target-lesion revascularization, restenosis, and stent thrombosis did not differ significantly between groups. A significantly higher proportion of patients in the FFR group reported chest discomfort during the procedure.
- Conclusion
- Among patients with stable angina or an acute coronary syndrome, iFR-guided revascularization was noninferior to FFR-guided revascularization for major adverse cardiac events at 12 months.
- Why it matters
- It provided clinical-outcome evidence supporting iFR as an alternative to FFR for guiding revascularization decisions, with a procedure that patients tolerate better.
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