Sex Differences in 5-Year Outcomes After Deferral of Revascularization Following Physiological Coronary Assessment

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Clinical Research

Background:

• Sex differences in cardiovascular disease outcomes are well-documented.
• The impact of sex on long-term results following non-invasive physiological assessment and deferred revascularization is not fully understood.
• Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are key physiological indices guiding revascularization decisions.

Purpose of the Study:

• To investigate the relationship between sex and long-term outcomes after FFR- and iFR-guided deferral of coronary revascularization.
• To compare the 5-year incidence of target vessel failure (TVF) between men and women in deferred lesions.

Main Methods:

• Analysis of data from the J-CONFIRM registry, including 432 lesions from 385 patients with paired FFR and iFR measurements.
• Patients were categorized by sex (men and women).
• The primary endpoint was the cumulative 5-year incidence of TVF (cardiac death, target vessel-myocardial infarction, or clinically driven target vessel revascularization).

Main Results:

• Median FFR was lower in men than women (P=0.002), but iFR values were comparable (P=0.26).
• Discordance between FFR and iFR was similar in frequency but differed in pattern between sexes (P=0.036).
• The adjusted 5-year cumulative incidence of TVF did not differ significantly between men and women (13.9% vs. 6.9%, adjusted HR 1.82; P=0.41).

Conclusions:

• While physiological indices like FFR show sex-based differences, these do not translate into different long-term clinical outcomes for deferred coronary lesions.
• Sex does not appear to be an independent predictor of 5-year target vessel failure after deferral guided by FFR/iFR.
• Further research may explore underlying mechanisms for observed differences in physiological index patterns between sexes.