Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve–Guided Revascularization Strategy

Chee Hae Kim; Bon Kwon Koo; Hakim Moulay Dehbi; Joo Myung Lee; Joon Hyung Doh; Chang Wook Nam; Eun Seok Shin; Christopher M. Cook; Rasha Al-Lamee; Ricardo Petraco; Sayan Sen; Iqbal S. Malik; Sukhjinder S. Nijjer; Hernán Mejía-Rentería; Eduardo Alegria-Barrero; Ali Alghamdi; John Altman; Sérgio B. Baptista; Ravinay Bhindi; Waldemar Bojara; Salvatore Brugaletta; Pedro Canas Silva; Carlo Di Mario; Andrejs Erglis; Robert T. Gerber; Olaf Going; Tobias Härle; Farrel Hellig; Ciro Indolfi; Luc Janssens; Allen Jeremias; Rajesh K. Kharbanda; Ahmed Khashaba; Yuetsu Kikuta; Florian Krackhardt; Mika Laine; Sam J. Lehman; Hitoshi Matsuo; Martijin Meuwissen; Giampaolo Niccoli; Jan J. Piek; Flavo Ribichini; Habib Samady; James Sapontis; Arnold H. Seto; Murat Sezer; Andrew S.P. Sharp; Jasvindar Singh; Hiroaki Takashima; Suneel Talwar; Nobuhiro Tanaka; Kare Tang; Eric Van Belle; Niels van Royen; Hugo Vinhas; Christiaan J. Vrints; Darren Walters; Hiroyoshi Yokoi; Bruce Samuels; Christopher Buller; Manesh R. Patel; Patrick W. Serruys; Javier Escaned; Justin E. Davies

doi:10.1016/j.jcin.2019.06.035

Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve–Guided Revascularization Strategy

Chee Hae Kim, Bon Kwon Koo, Hakim Moulay Dehbi, Joo Myung Lee, Joon Hyung Doh, Chang Wook Nam, Eun Seok Shin, Christopher M. Cook, Rasha Al-Lamee, Ricardo Petraco, Sayan Sen, Iqbal S. Malik, Sukhjinder S. Nijjer, Hernán Mejía-Rentería, Eduardo Alegria-Barrero, Ali Alghamdi, John Altman, Sérgio B. Baptista, Ravinay Bhindi, Waldemar BojaraSalvatore Brugaletta, Pedro Canas Silva, Carlo Di Mario, Andrejs Erglis, Robert T. Gerber, Olaf Going, Tobias Härle, Farrel Hellig, Ciro Indolfi, Luc Janssens, Allen Jeremias, Rajesh K. Kharbanda, Ahmed Khashaba, Yuetsu Kikuta, Florian Krackhardt, Mika Laine, Sam J. Lehman, Hitoshi Matsuo, Martijin Meuwissen, Giampaolo Niccoli, Jan J. Piek, Flavo Ribichini, Habib Samady, James Sapontis, Arnold H. Seto, Murat Sezer, Andrew S.P. Sharp, Jasvindar Singh, Hiroaki Takashima, Suneel Talwar, Nobuhiro Tanaka, Kare Tang, Eric Van Belle, Niels van Royen, Hugo Vinhas, Christiaan J. Vrints, Darren Walters, Hiroyoshi Yokoi, Bruce Samuels, Christopher Buller, Manesh R. Patel, Patrick W. Serruys, Javier Escaned, Justin E. Davies

Research output: Contribution to journal › Article › peer-review

16 Scopus citations

Abstract

Objectives: This study sought to evaluate sex differences in procedural characteristics and clinical outcomes of instantaneous wave-free ratio (iFR)– and fractional flow reserve (FFR)–guided revascularization strategies. Background: An iFR-guided strategy has shown a lower revascularization rate than an FFR-guided strategy, without differences in clinical outcomes. Methods: This is a post hoc analysis of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate stenosis to guide Revascularization) study, in which 601 women and 1,891 men were randomized to iFR- or FFR-guided strategy. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. Results: Among the entire population, women had a lower number of functionally significant lesions per patient (0.31 ± 0.51 vs. 0.43 ± 0.59; p < 0.001) and less frequently underwent revascularization than men (42.1% vs. 53.1%; p < 0.001). There was no difference in mean iFR value according to sex (0.91 ± 0.09 vs. 0.91 ± 0.10; p = 0.442). However, the mean FFR value was lower in men than in women (0.83 ± 0.09 vs. 0.85 ± 0.10; p = 0.001). In men, an FFR-guided strategy was associated with a higher rate of revascularization than an iFR-guided strategy (57.1% vs. 49.3%; p = 0.001), but this difference was not observed in women (41.4% vs. 42.6%; p = 0.757). There was no difference in MACE rates between iFR- and FFR-guided strategies in both women (5.4% vs. 5.6%, adjusted hazard ratio: 1.10; 95% confidence interval: 0.50 to 2.43; p = 0.805) and men (6.6% vs. 7.0%, adjusted hazard ratio: 0.98; 95% confidence interval: 0.66 to 1.46; p = 0.919). Conclusions: An FFR-guided strategy was associated with a higher rate of revascularization than iFR-guided strategy in men, but not in women. However, iFR- and FFR-guided strategies showed comparable clinical outcomes, regardless of sex.

Original language	English
Pages (from-to)	2035-2046
Number of pages	12
Journal	JACC: Cardiovascular Interventions
Volume	12
Issue number	20
DOIs	https://doi.org/10.1016/j.jcin.2019.06.035
State	Published - Oct 28 2019

Keywords

clinical outcome
fractional flow reserve
instantaneous wave-free ratio
sex

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10.1016/j.jcin.2019.06.035

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Kim, C. H., Koo, B. K., Dehbi, H. M., Lee, J. M., Doh, J. H., Nam, C. W., Shin, E. S., Cook, C. M., Al-Lamee, R., Petraco, R., Sen, S., Malik, I. S., Nijjer, S. S., Mejía-Rentería, H., Alegria-Barrero, E., Alghamdi, A., Altman, J., Baptista, S. B., Bhindi, R., ... Davies, J. E. (2019). Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve–Guided Revascularization Strategy. JACC: Cardiovascular Interventions, 12(20), 2035-2046. https://doi.org/10.1016/j.jcin.2019.06.035

@article{e59e4df2f54046a6989df9c87e77b447,

title = "Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve–Guided Revascularization Strategy",

abstract = "Objectives: This study sought to evaluate sex differences in procedural characteristics and clinical outcomes of instantaneous wave-free ratio (iFR)– and fractional flow reserve (FFR)–guided revascularization strategies. Background: An iFR-guided strategy has shown a lower revascularization rate than an FFR-guided strategy, without differences in clinical outcomes. Methods: This is a post hoc analysis of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate stenosis to guide Revascularization) study, in which 601 women and 1,891 men were randomized to iFR- or FFR-guided strategy. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. Results: Among the entire population, women had a lower number of functionally significant lesions per patient (0.31 ± 0.51 vs. 0.43 ± 0.59; p < 0.001) and less frequently underwent revascularization than men (42.1% vs. 53.1%; p < 0.001). There was no difference in mean iFR value according to sex (0.91 ± 0.09 vs. 0.91 ± 0.10; p = 0.442). However, the mean FFR value was lower in men than in women (0.83 ± 0.09 vs. 0.85 ± 0.10; p = 0.001). In men, an FFR-guided strategy was associated with a higher rate of revascularization than an iFR-guided strategy (57.1% vs. 49.3%; p = 0.001), but this difference was not observed in women (41.4% vs. 42.6%; p = 0.757). There was no difference in MACE rates between iFR- and FFR-guided strategies in both women (5.4% vs. 5.6%, adjusted hazard ratio: 1.10; 95% confidence interval: 0.50 to 2.43; p = 0.805) and men (6.6% vs. 7.0%, adjusted hazard ratio: 0.98; 95% confidence interval: 0.66 to 1.46; p = 0.919). Conclusions: An FFR-guided strategy was associated with a higher rate of revascularization than iFR-guided strategy in men, but not in women. However, iFR- and FFR-guided strategies showed comparable clinical outcomes, regardless of sex.",

keywords = "clinical outcome, fractional flow reserve, instantaneous wave-free ratio, sex",

author = "Kim, {Chee Hae} and Koo, {Bon Kwon} and Dehbi, {Hakim Moulay} and Lee, {Joo Myung} and Doh, {Joon Hyung} and Nam, {Chang Wook} and Shin, {Eun Seok} and Cook, {Christopher M.} and Rasha Al-Lamee and Ricardo Petraco and Sayan Sen and Malik, {Iqbal S.} and Nijjer, {Sukhjinder S.} and Hern{\'a}n Mej{\'i}a-Renter{\'i}a and Eduardo Alegria-Barrero and Ali Alghamdi and John Altman and Baptista, {S{\'e}rgio B.} and Ravinay Bhindi and Waldemar Bojara and Salvatore Brugaletta and Silva, {Pedro Canas} and {Di Mario}, Carlo and Andrejs Erglis and Gerber, {Robert T.} and Olaf Going and Tobias H{\"a}rle and Farrel Hellig and Ciro Indolfi and Luc Janssens and Allen Jeremias and Kharbanda, {Rajesh K.} and Ahmed Khashaba and Yuetsu Kikuta and Florian Krackhardt and Mika Laine and Lehman, {Sam J.} and Hitoshi Matsuo and Martijin Meuwissen and Giampaolo Niccoli and Piek, {Jan J.} and Flavo Ribichini and Habib Samady and James Sapontis and Seto, {Arnold H.} and Murat Sezer and Sharp, {Andrew S.P.} and Jasvindar Singh and Hiroaki Takashima and Suneel Talwar and Nobuhiro Tanaka and Kare Tang and {Van Belle}, Eric and {van Royen}, Niels and Hugo Vinhas and Vrints, {Christiaan J.} and Darren Walters and Hiroyoshi Yokoi and Bruce Samuels and Christopher Buller and Patel, {Manesh R.} and Serruys, {Patrick W.} and Javier Escaned and Davies, {Justin E.}",

note = "Funding Information: The DEFINE-FLAIR trial was supported by unrestricted educational grants from Philips (formerly Volcano Corporation) to Imperial College Trials Unit. This substudy received no additional funding. Dr. Bon-Kwon Koo received institutional research grant support from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Joo Myung Lee received a research grant support from St. Jude Medical (Abbott Vascular) and Philips Volcano. Drs. Al-Lamee, Cook, Di Mario, Kikuta, and Petraco has received personal fees from Philips Volcano. Dr. Baptista has received grants and consulting fees from Abbott; and has received personal fees from Boston Scientific and Philips Volcano, Opsens Medical, Abbott, and Heartflow. Dr. H{\"a}rle has received technical support of experimental studies from Philips Volcano. Dr. Jeremias has received personal fees from St. Jude Medical and Philips Volcano. Dr. Khashaba has received other support from Volcano Corporation. Dr. Laine has received grants from Imperial College London. Dr. Nijjer has received grants from the Medical Research Council (United Kingdom); and has received personal fees and nonfinancial support from Philips Volcano. Dr. Buller is a consultant to Abbott Vascular, Philip Volcano, Teleflex Inc., and Soundbite Medical. Dr. Patel has received grants and personal fees from Volcano, AstraZeneca, and Janssen; and has received and personal fees from Bayer. Dr. Piek has received grants and personal fees from Abbott Vascular, Philips Volcano, and Miracor. Dr. Samady has served on the Medical Advisory Board for Philips Volcano; has received institutional research grants from Abbott Vascular, Medtronic, Gilead, and Philips Volcano; and owns equity in SIG and Covanos. Dr. Sen has received grants from Volcano Corporation, AstraZeneca, Medtronic, and Philips; served on the Speakers Bureau for AstraZeneca and Philips; and has received speaker fees from Philips and Pfizer. Dr. Seto has received grant support from and served on the Speakers Bureau for Volcano Corporation, Abbott, and Philips. Dr. Sharp has received personal fees from Philips Volcano and Medtronic. Dr. Singh has received personal fees from Volcano Corporation. Dr. Tanaka has received personal fees from Volcano Corporation (Japan), St. Jude Medical, and Boston Scientific. Dr. Van Belle has received personal fees from Philips Volcano; and has served as a consultant for St. Jude Medical. Dr. van Royen has received grants and personal fees from Abbott, Philips, AstraZeneca, Biotronik, Boston Scientific, Microport, Amgen, Volcano Corporation, and St. Jude Medical. Dr. Vinhas has received personal fees from Volcano Corporation. Dr. Samuel has received consulting/speaker fees from Philips Medical and Abbott Vascular. Dr. Patel has received research grant support from Philips Volcano, Bayer, and Janssen; and served on the advisory board for Bayer and Janssen. Dr. Serruys has received personal fees from Abbott, AstraZeneca, Biotronik, Cardialysis, GLG Research, Medtronic, Sinomedical, Soci{\'e}t{\'e} Europa Digital, and Publishing, Stentys, Svelte, Philips Volcano, St. Jude Medical, Qualimed, and Xeltis. Dr. Escaned has received personal fees from Philips Volcano, Boston Scientific, and Abbott/St. Jude Medical. Dr. Davies has received grants and personal fees from Volcano Corporation, Medtronic, and ReCor Medical; has received personal fees from Imperial College London and AstraZeneca; and has patents WO2011110817 A2, US9339348 B2, WO2015013134 A3, EP3021741 A2, and US20150025330 A1 issued to Imperial College London and licensed to Volcano Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2019 American College of Cardiology Foundation",

year = "2019",

month = oct,

day = "28",

doi = "10.1016/j.jcin.2019.06.035",

language = "English",

volume = "12",

pages = "2035--2046",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

number = "20",

}

Kim, CH, Koo, BK, Dehbi, HM, Lee, JM, Doh, JH, Nam, CW, Shin, ES, Cook, CM, Al-Lamee, R, Petraco, R, Sen, S, Malik, IS, Nijjer, SS, Mejía-Rentería, H, Alegria-Barrero, E, Alghamdi, A, Altman, J, Baptista, SB, Bhindi, R, Bojara, W, Brugaletta, S, Silva, PC, Di Mario, C, Erglis, A, Gerber, RT, Going, O, Härle, T, Hellig, F, Indolfi, C, Janssens, L, Jeremias, A, Kharbanda, RK, Khashaba, A, Kikuta, Y, Krackhardt, F, Laine, M, Lehman, SJ, Matsuo, H, Meuwissen, M, Niccoli, G, Piek, JJ, Ribichini, F, Samady, H, Sapontis, J, Seto, AH, Sezer, M, Sharp, ASP, Singh, J, Takashima, H, Talwar, S, Tanaka, N, Tang, K, Van Belle, E, van Royen, N, Vinhas, H, Vrints, CJ, Walters, D, Yokoi, H, Samuels, B, Buller, C, Patel, MR, Serruys, PW, Escaned, J & Davies, JE 2019, 'Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve–Guided Revascularization Strategy', JACC: Cardiovascular Interventions, vol. 12, no. 20, pp. 2035-2046. https://doi.org/10.1016/j.jcin.2019.06.035

TY - JOUR

T1 - Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve–Guided Revascularization Strategy

AU - Kim, Chee Hae

AU - Koo, Bon Kwon

AU - Dehbi, Hakim Moulay

AU - Lee, Joo Myung

AU - Doh, Joon Hyung

AU - Nam, Chang Wook

AU - Shin, Eun Seok

AU - Cook, Christopher M.

AU - Al-Lamee, Rasha

AU - Petraco, Ricardo

AU - Sen, Sayan

AU - Malik, Iqbal S.

AU - Nijjer, Sukhjinder S.

AU - Mejía-Rentería, Hernán

AU - Alegria-Barrero, Eduardo

AU - Alghamdi, Ali

AU - Altman, John

AU - Baptista, Sérgio B.

AU - Bhindi, Ravinay

AU - Bojara, Waldemar

AU - Brugaletta, Salvatore

AU - Silva, Pedro Canas

AU - Di Mario, Carlo

AU - Erglis, Andrejs

AU - Gerber, Robert T.

AU - Going, Olaf

AU - Härle, Tobias

AU - Hellig, Farrel

AU - Indolfi, Ciro

AU - Janssens, Luc

AU - Jeremias, Allen

AU - Kharbanda, Rajesh K.

AU - Khashaba, Ahmed

AU - Kikuta, Yuetsu

AU - Krackhardt, Florian

AU - Laine, Mika

AU - Lehman, Sam J.

AU - Matsuo, Hitoshi

AU - Meuwissen, Martijin

AU - Niccoli, Giampaolo

AU - Piek, Jan J.

AU - Ribichini, Flavo

AU - Samady, Habib

AU - Sapontis, James

AU - Seto, Arnold H.

AU - Sezer, Murat

AU - Sharp, Andrew S.P.

AU - Singh, Jasvindar

AU - Takashima, Hiroaki

AU - Talwar, Suneel

AU - Tanaka, Nobuhiro

AU - Tang, Kare

AU - Van Belle, Eric

AU - van Royen, Niels

AU - Vinhas, Hugo

AU - Vrints, Christiaan J.

AU - Walters, Darren

AU - Yokoi, Hiroyoshi

AU - Samuels, Bruce

AU - Buller, Christopher

AU - Patel, Manesh R.

AU - Serruys, Patrick W.

AU - Escaned, Javier

AU - Davies, Justin E.

N1 - Funding Information: The DEFINE-FLAIR trial was supported by unrestricted educational grants from Philips (formerly Volcano Corporation) to Imperial College Trials Unit. This substudy received no additional funding. Dr. Bon-Kwon Koo received institutional research grant support from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr. Joo Myung Lee received a research grant support from St. Jude Medical (Abbott Vascular) and Philips Volcano. Drs. Al-Lamee, Cook, Di Mario, Kikuta, and Petraco has received personal fees from Philips Volcano. Dr. Baptista has received grants and consulting fees from Abbott; and has received personal fees from Boston Scientific and Philips Volcano, Opsens Medical, Abbott, and Heartflow. Dr. Härle has received technical support of experimental studies from Philips Volcano. Dr. Jeremias has received personal fees from St. Jude Medical and Philips Volcano. Dr. Khashaba has received other support from Volcano Corporation. Dr. Laine has received grants from Imperial College London. Dr. Nijjer has received grants from the Medical Research Council (United Kingdom); and has received personal fees and nonfinancial support from Philips Volcano. Dr. Buller is a consultant to Abbott Vascular, Philip Volcano, Teleflex Inc., and Soundbite Medical. Dr. Patel has received grants and personal fees from Volcano, AstraZeneca, and Janssen; and has received and personal fees from Bayer. Dr. Piek has received grants and personal fees from Abbott Vascular, Philips Volcano, and Miracor. Dr. Samady has served on the Medical Advisory Board for Philips Volcano; has received institutional research grants from Abbott Vascular, Medtronic, Gilead, and Philips Volcano; and owns equity in SIG and Covanos. Dr. Sen has received grants from Volcano Corporation, AstraZeneca, Medtronic, and Philips; served on the Speakers Bureau for AstraZeneca and Philips; and has received speaker fees from Philips and Pfizer. Dr. Seto has received grant support from and served on the Speakers Bureau for Volcano Corporation, Abbott, and Philips. Dr. Sharp has received personal fees from Philips Volcano and Medtronic. Dr. Singh has received personal fees from Volcano Corporation. Dr. Tanaka has received personal fees from Volcano Corporation (Japan), St. Jude Medical, and Boston Scientific. Dr. Van Belle has received personal fees from Philips Volcano; and has served as a consultant for St. Jude Medical. Dr. van Royen has received grants and personal fees from Abbott, Philips, AstraZeneca, Biotronik, Boston Scientific, Microport, Amgen, Volcano Corporation, and St. Jude Medical. Dr. Vinhas has received personal fees from Volcano Corporation. Dr. Samuel has received consulting/speaker fees from Philips Medical and Abbott Vascular. Dr. Patel has received research grant support from Philips Volcano, Bayer, and Janssen; and served on the advisory board for Bayer and Janssen. Dr. Serruys has received personal fees from Abbott, AstraZeneca, Biotronik, Cardialysis, GLG Research, Medtronic, Sinomedical, Société Europa Digital, and Publishing, Stentys, Svelte, Philips Volcano, St. Jude Medical, Qualimed, and Xeltis. Dr. Escaned has received personal fees from Philips Volcano, Boston Scientific, and Abbott/St. Jude Medical. Dr. Davies has received grants and personal fees from Volcano Corporation, Medtronic, and ReCor Medical; has received personal fees from Imperial College London and AstraZeneca; and has patents WO2011110817 A2, US9339348 B2, WO2015013134 A3, EP3021741 A2, and US20150025330 A1 issued to Imperial College London and licensed to Volcano Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2019 American College of Cardiology Foundation

PY - 2019/10/28

Y1 - 2019/10/28

N2 - Objectives: This study sought to evaluate sex differences in procedural characteristics and clinical outcomes of instantaneous wave-free ratio (iFR)– and fractional flow reserve (FFR)–guided revascularization strategies. Background: An iFR-guided strategy has shown a lower revascularization rate than an FFR-guided strategy, without differences in clinical outcomes. Methods: This is a post hoc analysis of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate stenosis to guide Revascularization) study, in which 601 women and 1,891 men were randomized to iFR- or FFR-guided strategy. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. Results: Among the entire population, women had a lower number of functionally significant lesions per patient (0.31 ± 0.51 vs. 0.43 ± 0.59; p < 0.001) and less frequently underwent revascularization than men (42.1% vs. 53.1%; p < 0.001). There was no difference in mean iFR value according to sex (0.91 ± 0.09 vs. 0.91 ± 0.10; p = 0.442). However, the mean FFR value was lower in men than in women (0.83 ± 0.09 vs. 0.85 ± 0.10; p = 0.001). In men, an FFR-guided strategy was associated with a higher rate of revascularization than an iFR-guided strategy (57.1% vs. 49.3%; p = 0.001), but this difference was not observed in women (41.4% vs. 42.6%; p = 0.757). There was no difference in MACE rates between iFR- and FFR-guided strategies in both women (5.4% vs. 5.6%, adjusted hazard ratio: 1.10; 95% confidence interval: 0.50 to 2.43; p = 0.805) and men (6.6% vs. 7.0%, adjusted hazard ratio: 0.98; 95% confidence interval: 0.66 to 1.46; p = 0.919). Conclusions: An FFR-guided strategy was associated with a higher rate of revascularization than iFR-guided strategy in men, but not in women. However, iFR- and FFR-guided strategies showed comparable clinical outcomes, regardless of sex.

AB - Objectives: This study sought to evaluate sex differences in procedural characteristics and clinical outcomes of instantaneous wave-free ratio (iFR)– and fractional flow reserve (FFR)–guided revascularization strategies. Background: An iFR-guided strategy has shown a lower revascularization rate than an FFR-guided strategy, without differences in clinical outcomes. Methods: This is a post hoc analysis of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate stenosis to guide Revascularization) study, in which 601 women and 1,891 men were randomized to iFR- or FFR-guided strategy. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. Results: Among the entire population, women had a lower number of functionally significant lesions per patient (0.31 ± 0.51 vs. 0.43 ± 0.59; p < 0.001) and less frequently underwent revascularization than men (42.1% vs. 53.1%; p < 0.001). There was no difference in mean iFR value according to sex (0.91 ± 0.09 vs. 0.91 ± 0.10; p = 0.442). However, the mean FFR value was lower in men than in women (0.83 ± 0.09 vs. 0.85 ± 0.10; p = 0.001). In men, an FFR-guided strategy was associated with a higher rate of revascularization than an iFR-guided strategy (57.1% vs. 49.3%; p = 0.001), but this difference was not observed in women (41.4% vs. 42.6%; p = 0.757). There was no difference in MACE rates between iFR- and FFR-guided strategies in both women (5.4% vs. 5.6%, adjusted hazard ratio: 1.10; 95% confidence interval: 0.50 to 2.43; p = 0.805) and men (6.6% vs. 7.0%, adjusted hazard ratio: 0.98; 95% confidence interval: 0.66 to 1.46; p = 0.919). Conclusions: An FFR-guided strategy was associated with a higher rate of revascularization than iFR-guided strategy in men, but not in women. However, iFR- and FFR-guided strategies showed comparable clinical outcomes, regardless of sex.

KW - clinical outcome

KW - fractional flow reserve

KW - instantaneous wave-free ratio

KW - sex

UR - http://www.scopus.com/inward/record.url?scp=85073062022&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2019.06.035

DO - 10.1016/j.jcin.2019.06.035

M3 - Article

C2 - 31648764

AN - SCOPUS:85073062022

SN - 1936-8798

VL - 12

SP - 2035

EP - 2046

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 20

ER -

Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve–Guided Revascularization Strategy

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