{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:08:30Z","timestamp":1791983310934,"version":"4.4.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"41","license":[{"start":{"date-parts":[[2023,8,27]],"date-time":"2023-08-27T00:00:00Z","timestamp":1693094400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background and Aims<\/jats:title>\n                  <jats:p>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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Composite of major adverse cardiovascular events (MACE) and its individual components [all-cause death, myocardial infarction (MI), and unplanned revascularisation] were analysed. Raw Kaplan\u2013Meier 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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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].<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehad582","type":"journal-article","created":{"date-parts":[[2023,8,27]],"date-time":"2023-08-27T14:16:22Z","timestamp":1693145782000},"page":"4376-4384","source":"Crossref","is-referenced-by-count":60,"title":["Instantaneous wave free ratio vs. fractional flow reserve and 5-year mortality: iFR SWEDEHEART and DEFINE FLAIR"],"prefix":"10.1093","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2871-8279","authenticated-orcid":false,"given":"Ashkan","family":"Eftekhari","sequence":"first","affiliation":[{"name":"Department Cardiology, Aalborg University Hospital , Hobrovej 18-22, 9000 Aalborg , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emil Nielsen","family":"Holck","sequence":"additional","affiliation":[{"name":"Department Cardiology, Aarhus University Hospital , Denmark"},{"name":"Department Clinical Medicine, Health, Aarhus University , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1926-0844","authenticated-orcid":false,"given":"Jelmer","family":"Westra","sequence":"additional","affiliation":[{"name":"Department Cardiology, Aarhus University Hospital , Denmark"},{"name":"Department Cardiology, Link\u00f6ping University Hospital , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels Thue","family":"Olsen","sequence":"additional","affiliation":[{"name":"Department Cardiology, Gentofte University Hospital , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels Henrik","family":"Bruun","sequence":"additional","affiliation":[{"name":"Unit of Clinical Biostatistics, Aalborg University Hospital , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4838-2429","authenticated-orcid":false,"given":"Lisette Okkels","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department Cardiology, Odense University Hospital , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5436-9194","authenticated-orcid":false,"given":"Thomas","family":"Engstr\u00f8m","sequence":"additional","affiliation":[{"name":"Department Cardiology, Rigshospitalet Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8740-4862","authenticated-orcid":false,"given":"Evald H\u00f8j","family":"Christiansen","sequence":"additional","affiliation":[{"name":"Department Cardiology, Aarhus University Hospital , Denmark"},{"name":"Department Clinical Medicine, Health, Aarhus University , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,8,27]]},"reference":[{"key":"2023110616364270000_ehad582-B1","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/eurheartj\/ehz425","article-title":"2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes","volume":"41","author":"Knuuti","year":"2020","journal-title":"Eur Heart J"},{"key":"2023110616364270000_ehad582-B2","first-page":"e4","article-title":"2021 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":"145","author":"Lawton","year":"2022","journal-title":"Circulation"},{"key":"2023110616364270000_ehad582-B3","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1056\/NEJM197907123010201","article-title":"Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty","volume":"301","author":"Gr\u00fcntzig","year":"1979","journal-title":"N Engl J Med"},{"key":"2023110616364270000_ehad582-B4","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1161\/01.CIR.87.4.1354","article-title":"Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty","volume":"87","author":"Pijls","year":"1993","journal-title":"Circulation"},{"key":"2023110616364270000_ehad582-B5","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1161\/01.CIR.89.3.1013","article-title":"Coronary flow reserve calculated from pressure measurements in humans. 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