Analysis Shows iFR and FFR are Equally Safe to Diagnose and Treat Heart Disease

Royal Philips is sharing promising results about the safety of its instant wave-free ratio (iFR) in percutaneous coronary intervention (PCI) guidance.

iFR is a pressure-derived index only offered by Philips that is used to assess coronary blockages during interventional procedures. iFR avoids the use of hyperemic agents, a class of drugs that maximize blood flow but have a significant impact on the patient experience.³
 
A longitudinal analysis from the National Swedeheart Quality Registry of more than 42,000 patients undergoing coronary procedures showed no difference between iFR and fractional flow reserve (FFR) in major adverse cardiac events (MACE).⁴ The analysis, “Long-term Safety of Revascularization Deferral Based on Instantaneous Wave-Free Ratio or Fractional Reserve,” compares patient outcomes using iFR and FFR in the diagnosis and treatment of heart disease.
 
“These new findings once again confirm the safety of iFR. We continue to see that iFR-guided treatment offers consistent outcomes, reduces costs, and provides a better patient experience,” said Dr. Götberg, Department of Cardiology, Clinical Sciences, Lund University, Sweden. “The data from this new analysis provides additional confidence in the safety of iFR for physicians.”
 
In a previously published five-year analysis of the randomized trial iFR-SWEDEHEART, results found iFR and FFR to be equally safe and effective regarding MACE risks. The cumulative MACE risks for each group differentiated by 1.6% (iFR: 21.5%, FFR: 19.9%, HR 1.09 (95% CI: 0.90-1.33 at five years). There was no difference in risk for death, heart attack or new revascularization.³
 
The results presented from the SWEDEHEART registry revealed that patients in the iFR group had more risk factors compared with the FFR group but when adjusted for known confounders there was no difference in five-year MACE between patients who underwent iFR or FFR-guided revascularization (32.2% vs. 31.3%, adjusted HR 0.99, 95%CI 0.93–1.05, p=0.65). Furthermore, the outcome was similar in the individual components of MACE (death, heart attack, new revascularization) as well as in both deferred and treated subgroups.
 
iFR is considered the Gold Standard for hyperemia-free physiologic assessment for measuring pressure in diagnostic and interventional procedures.^1,4 Similar to FFR, clinicians use these tools coupled with angiographic images to assess coronary blockages. However, by avoiding administrating a hyperemic agent, patient discomfort can be reduced by 95.7% and enables iFR to detect disease processes downstream from the major blood vessels.⁴
 
Only Philips iFR has a Class IA recommendation by the American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography & Interventions and European Society of Cardiology.^1,2
 
“We are confident in our pursuit of innovation to improve outcomes and ensure patient safety. The data continues to demonstrate the benefits of iFR-guided treatment to reduce costs and improve outcomes,” stated Chris Landon, general manager, Philips Image Guided Therapy Devices. “iFR technology is unique to Philips, and we are proud to offer the global gold standard treatment for patients with ischemic heart disease.”
 
Royal Philips is focused on improving people’s health and well-being through meaningful innovation. Philips’ patient- and people-centric innovation leverages advanced technology and deep clinical and consumer insights to deliver personal health solutions for consumers and professional health solutions for healthcare providers and their patients in the hospital and the home. Headquartered in The Netherlands, the company is a leader in diagnostic imaging, ultrasound, image-guided therapy, monitoring and enterprise informatics, as well as in personal health. Philips generated €17.8 billion in 2022 sales and employs approximately 70,700 employees with sales and services in more than 100 countries. 

References 
¹ Lawton J. et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization. JACC. 2022;79(2):e21-e129.
² 2018 ESC/EACTS Guidelines on myocardial revascularization: The task force on myocardial revascularization of the European society of cardiology (ESC) and European association for cardio-thoracic surgery (EACTS). Eur Heart J. 2018;00:1-96. Japan guidelines.
³ Gotberg M, et al. Instantaneous wave-free ratio compared with fractional flow reserve in PCI: A cost-minimization analysis. Int J Cardiol 2021 1;344:54-59.
⁴ Gotberg M, Berntorp K, Rylance R, et al. 5 – Year outcomes of PCI guided by measurement of instantaneous wave-free ratio versus fractional flow reserve. J Am Coll Cardiol. 2022;79(10):965–974.