Relationship between instantaneous wave-free ratio and fractional flow reserve in elderly patients with mild to moderate coronary artery stenosis and its prognostic significance
MA Ruofei
ZHAO Bo
LEI Jiang
SUN Yue
Abstract：Objective To investigate the relationship between instantaneous wave-free ratio(iFR)and fractional flow reserve(FFR)in elderly patients with mild to moderate coronary artery stenosis and its prognostic significance.Methods From January 2020 to May 2022,293 elderly patients with stable coronary artery disease(CAD)who underwent coronary angiography were continuously enrolled in The First Affiliated Hospital of Xi'an Medical College.FFR and iFR were measured by quantitative coronary angiography and intracoronary pressure wire technique.The primary outcome was major adverse cardiovascular events(MACE),and the secondary outcome was defined as a composite of myocardial infarction(MI)and events requiring emergency revascularization.Results The area under ROC curve of iFR as a physiological significance index(FFR≤0.80)was 0.893(95%CI:0.860～0.926,P<0.001),and the corresponding cutoff value was 0.93(specificity 81.2%,sensitivity 81.7%).By Spearman analysis,iFR and FFR were positively correlated(P<0.001).However,a mismatch between iFR and FFR was observed in 18.44%of lesions.Multivariate Logistic regression analysis showed that after adjusting for FFR,estimated glomerular filtration rate,diabetes mellitus,aortic stenosis,high-sensitivity C-reactive protein,lesion location,minimum lumen diameter,and diffuse lesions were still independent influencing factors for iFR(P<0.05).The rates of MACE and MI/need for emergency revascularization in patients with inconsistent FFR and iFR were significantly higher than those in patients with consistent FFR and iFR(P<0.05).Kaplan-Meier analysis showed that compared with patients with iFR>0.93,patients with iFR≤0.93 had significantly worse prognosis in terms of MACE and MI/need for urgent revascularization(P<0.05).However,FFR was not significantly associated with MACE or MI/need for emergency revascularization prognosis(P>0.05).Conclusion iFR and FFR are positively correlated,but there is still a certain degree of inconsistency.In elderly patients with mild to moderate coronary artery stenosis,iFR may provide more information about coronary ischemia and prognosis than FFR,and it may be more useful to develop revascularization strategies and predict adverse events based on iFR than on FFR.
Keywords：mild to moderate coronary artery stenosisinstantaneous wave-free ratiofractional flow reserveprognosis
Publication Date：2025-12-20
Online Publishing Date：2026-03-25(First online date of this platform, not the publication date of the document)
Pages：7( 1435-1441 )