Revascularisation for CAD in T2D: which guidance approach is best?

  • Lee JM & al.
  • JAMA Cardiol
  • 17 Jul 2019

  • International Clinical Digest
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Takeaway

  • 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.

Study design

  • 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).

Key results

  • 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).

Limitations

  • Exploratory post hoc analysis.
  • Detailed data on diabetes status and treatment unavailable.