Additional Value of Instant Wave Free Ratio (iFR) on Standard Quantitative Coronary Angiography (QCA) in Cancer Patients
Journal of the Society for Cardiovascular Angiography & Interventions
We performed the first dedicated report on outcomes of an instantaneous wave free ratio (iFR) guided approach in cancer patients with stable coronary artery disease (CAD).
We included 41 cancer patients with stable CAD who underwent iFR guided percutaneous coronary intervention (PCI) from 2016-2020. Clinical endpoints included procedure related complications (bleeding, coronary dissection/perforation, and renal insufficiency) and major adverse cardiovascular events (MACE; myocardial infarction, heart failure, PCI, coronary artery bypass grafting, and cardiac death). Patient demographical characteristics were summarized using mean (SD) and median (minimum-maximum) for continuous variables and counts (%) for categorical variables. Univariate Cox regression models were utilized to identify variables that were associated with overall survival. Overall survival time was defined as time interval from cath exam to death or last follow-up.
Out of 41 subjects, 7 patients had ≥70% stenosis by QCA (severe), and 34 patients had 50-69% stenosis (intermediate). In the severe stenosis group, 3 (43%) had an iFR ≥0.9 and lesions were reclassified as moderate with no PCI or dual antiplatelet therapy (DAPT). In the intermediate stenosis group 16 (47%) had an iFR ≤0.89 and were reclassified as severe, of whom 10 patients received PCI and DAPT. There was a moderate negative correlation (Pearson correlation coefficient =0.47) between QCA and iFR. All cases were technically successful with no MACE. Over a median of 23.5 months of follow-up, 15 (37%) non-cardiac deaths occurred. By univariate cox regression, only smoking (p=0.09) showed marginal significance with survival. Age, stenosis, iFR, hemoglobin, platelet, gender, diabetes, hypertension, hyperlipidemia, malignancy type, revascularization did not show significant effect on survival.
Our high technical success rate and lack of adverse events supports that iFR is a safe and reliable technique in cancer patients. The high rate of bidirectional reclassification between intermediate severe lesions suggests that iFR can prevent both unnecessary revascularization and undertreatment of CAD.
Kim JW, Jacob R, Daya T, Song J, Monlezun DJ, Honan KA, et al. [Balanescu DV, Donisan T]. Additional value of instant wave free ration (iFR) on standard quantitative coronary angiography (QCA) in cancer patients. J Soc Cardiovasc Angiogr Interv. 2022 May-Jun;1(3 Suppl):100217. doi:10.1016/j.jscai.2022.100217.