Immediate and long-term outcomes of instantaneous wave-free ratio-guided endovascular treatment of patients with diffuse and multilevel coronary artery disease

Aim. To compare the immediate and long-term outcomes of percutaneous coronary intervention (PCI) with and without instantaneous wave-free ratio (iFR) monitoring in patients with diffuse and multilevel coronary artery disease (CAD).

Material and methods. The study prospectively enrolled 100 patients who underwent PCI for stable CAD with diffuse and/or multilevel involvement of target coronary artery. Comparison group was retrospectively matched using a propensity score matching. The study group had iFR-guided PCI (n=100), while the comparison group — standard PCI without iFR monitoring (n=100). Long-term outcomes were assessed in 198 (99,0%) patients.

Results. The study group had a lower number of implanted stents (1,2±0,4 vs 1,6±0,5; p<0,001) and a lower length of stented segments (45,4±14,1 vs 58,7±15,9 mm; p<0,001). The use of iFR monitoring reduced the number of stenoses treated with PCI by 32%. Diffuse involvement was associated with a 6-fold increase in the odds of failing to achieve an iFR ≥0,9 compared to local changes (odds ratio (OR) 6,11; 95% CI 1,44-25,92). Both groups had comparable 12-month risk of achieving the composite endpoint (hazard ratio (HR) 0,51; 95% CI 0,17-1,59; p=0,2460).

Conclusion. In patients with diffuse and multilevel coronary artery disease (CAD), iFR-guided PCI allows for a reduction in the number and length of implanted stents by eliminating the need for stenting functionally insignificant stenoses, with comparable 12-month survival to standard PCI.

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