{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:52:21Z","timestamp":1791183141207,"version":"4.1.0"},"reference-count":9,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fractional flow reserve (FFR) is the reference standard for invasive physiological assessment of intermediate coronary stenoses. Instantaneous wave\u2010free ratio (iFR) was introduced as a non\u2010hyperemic alternative, and the DEFINE\u2010FLAIR and iFR\u2010SWEDEHEART trials demonstrated noninferiority of iFR\u2010 versus FFR\u2010guided management at 1 year, leading to widespread adoption of iFR. However, long\u2010term follow\u2010up and pooled analyses subsequently suggested higher all\u2010cause mortality with iFR\u2010guided assessment. We therefore compared long\u2010term outcomes of iFR\u2010 versus FFR\u2010guided coronary physiology assessment in real\u2010world clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single\u2010center study included consecutive patients undergoing invasive physiological assessment between 2012 and 2022. Patients were managed according to FFR\u2010 or iFR\u2010guided strategies, with revascularization performed for physiologically significant lesions and deferred otherwise. The primary endpoint was all\u2010cause mortality. Secondary endpoints included major adverse cardiovascular events (death from any cause, myocardial infarction or unplanned revascularization), and the individual componentes of the secondary composite endpoint. Time\u2010to\u2010event analyses were performed using Kaplan\u2013Meier estimates and Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1104 patients were included, comprising 428 patients in the FFR group and 676 in the iFR group. Baseline clinical characteristics were well balanced between groups. Functionally significant stenoses were less frequently identified in the iFR group (42% vs. 49%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), resulting in higher rates of revascularization deferral. During long\u2010term follow\u2010up, iFR\u2010guided management was associated with significantly higher all\u2010cause mortality compared with FFR\u2010guided management (HR 1.52, 95% CI 1.19\u20131.93;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The incidence of MACE was also significantly higher with iFR (HR 1.47, 95% CI 1.19\u20131.82;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), driven by mortality, with no differences in myocardial infarction or unplanned revascularization.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this large real\u2010world cohort, iFR\u2010guided coronary physiological assessment was associated with higher long\u2010term all\u2010cause mortality and MACE compared with FFR\u2010guided management, while rates of myocardial infarction and unplanned revascularization were similar. These findings parallel long\u2010term observations from randomized clinical trials and support the need for further studies evaluating the prognostic implications of resting versus hyperemic physiological indices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70930","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:25:04Z","timestamp":1791181504000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long\u2010Term Outcomes of iFR\u2010 Versus FFR\u2010Guided Coronary Physiology in Real\u2010World Clinical Practice"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0841-5600","authenticated-orcid":false,"given":"Diogo","family":"Ferreira","sequence":"first","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Vilela","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0277-7398","authenticated-orcid":false,"given":"Daniel","family":"Cazeiro","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e1tia","family":"Silva","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Raposo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4857-0910","authenticated-orcid":false,"given":"Catarina","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiago","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0087-8641","authenticated-orcid":false,"given":"Ana Rita","family":"Francisco","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Carrilho","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cl\u00e1udia","family":"Jorge","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8988-5412","authenticated-orcid":false,"given":"Jo\u00e3o Silva","family":"Marques","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Duarte","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Marques","family":"da Costa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Pinto","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8034-4529","authenticated-orcid":false,"given":"Fausto","family":"Pinto","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel Nobre","family":"Menezes","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital de Santa Maria (ULSSM), CAML, CCUL@RISE, Faculdade de Medicina Universidade de Lisboa Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1056\/NEJMoa1205361","article-title":"Fractional Flow Reserve\u2010Guided PCI Versus Medical Therapy in Stable Coronary Disease","volume":"367","author":"De Bruyne B.","year":"2012","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1056\/NEJMoa1803538","article-title":"Five\u2010Year Outcomes With PCI Guided by Fractional Flow Reserve","volume":"379","author":"Xaplanteris P.","year":"2018","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1056\/NEJMoa1700445","article-title":"Use of the Instantaneous Wave\u2010Free Ratio or Fractional Flow Reserve in PCI","volume":"376","author":"Davies J. E.","year":"2017","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1056\/NEJMoa1616540","article-title":"Instantaneous Wave\u2010Free Ratio Versus Fractional Flow Reserve to Guide PCI","volume":"376","author":"G\u00f6tberg M.","year":"2017","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC Guidelines for the Management of Chronic Coronary Syndromes","volume":"45","author":"Vrints C.","year":"2024","journal-title":"European Heart Journal"},{"issue":"197","key":"e_1_2_11_7_1","first-page":"2022","article-title":"ACC\/AHA\/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"79","author":"Writing Committee Members","year":"2021","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1001\/jamacardio.2024.3314","article-title":"Coronary Revascularization Guided With Fractional Flow Reserve or Instantaneous Wave\u2010Free Ratio: A 5\u2010Year Follow\u2010up of the DEFINE FLAIR Randomized Clinical Trial","volume":"10","author":"Escaned J.","year":"2025","journal-title":"JAMA Cardiology"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.122.028423","article-title":"Clinical Outcome of Revascularization Deferral With Instantaneous Wave\u2010Free Ratio and Fractional Flow Reserve: A 5\u2010Year Follow\u2010up Substudy From the iFR\u2010SWEDEHEART Trial","volume":"12","author":"Berntorp K.","year":"2023","journal-title":"Journal of the American Heart Association"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"4388","DOI":"10.1093\/eurheartj\/ehad552","article-title":"Coronary Revascularization Guided by Instantaneous Wave\u2010Free Ratio Compared With Fractional Flow Reserve: Pooled 5\u2010Year Mortality in the DEFINE\u2010FLAIR and iFR\u2010SWEDEHEART Trials","volume":"44","author":"Berry C.","year":"2023","journal-title":"European Heart Journal"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70930","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.70930","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70930","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:25:06Z","timestamp":1791181506000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70930"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,4]]},"references-count":9,"alternative-id":["10.1002\/ccd.70930"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70930","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,4]]},"assertion":[{"value":"2026-06-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ccd.70930"}}