- In revascularisation for patients with type 2 diabetes (T2D) and coronary artery disease (CAD), 1-year outcomes are similar between fractional flow reserve (FFR) vs instantaneous wave-free ratio (iFR) invasive guidance.
Why this matters
- Both FFR and iFR are used in clinical practice, but outcomes in patients with diabetes had not previously been fully investigated.
- Secondary analysis of 758 subjects with T2D and 1707 without in the randomised DEFINE-FLAIR trial comparing FFR-guided vs iFR-guided revascularisation.
- Revascularisation criteria were FFR ≤0.80 and iFR ≤0.89, with deferral if higher.
- Primary endpoint was major adverse cardiac events (MACEs): composite of all-cause death, nonfatal myocardial infarction (MI), or unplanned revascularisation at 1 year.
- Funding: Philips (formerly Volcano Corporation).
- Deferral was higher overall with iFR vs FFR (56.5% vs 46.6%; P<.001 but no difference in the t2d population vs respectively p=".15).</li">
- MACE risk was higher in T2D vs non-T2D population (8.6% vs 5.6%; adjusted HR, 1.84; P<.001 mainly driven by nonfatal mi and unplanned revascularisation.>
- Comparable MACE risk for iFR-guided and FFR-guided groups in both the nondiabetes (adjusted HR, 0.83; P=.45) and T2D populations (1.33; P=.25).
- Exploratory post hoc analysis.
- Detailed data on diabetes status and treatment unavailable.