Clinical outcomes of physiologically-guided revascularisation

Objective: To assess the clinical outcomes of revascularisation based on fractional flow reserve (FFR) and/or instantaneous wave-free ratio (iFR). Study Design: Descriptive study. Place and Duration of Study: Department of Medicine, The Aga Khan University Hospital, Karachi from January 2012 to January 2020. Methodology: A cohort of patients having moderate to severe coronary stenosis, undergoing coronary revascularisation based on invasive physiological assessment (FFR or iFR) were assessed. The participants were divided into the revascularisation-deferred group and the revascularization-performed group, based on the physiological results. Cox-proportional hazard model building was done, using a stepwise approach by assessing all plausible interactions and considering p-value ≤0.05 as statistically significant. Results: The frequency of major adverse cardiac event (MACE) and target vessel revascularisation was 8.4% and 3.2% in the revascularisation-performed group as compared to 6.4% and 3.2% in the revascularisation-deferred group. In adjusted models, no statistically significant difference was noted in MACE when comparing the revascularisation-performed group with a deferred group. Conclusion: Revascularisation guided by invasive physiological assessment with FFR or iFR is clinically safe and led to better resource utilisation.