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Updated: Jan 9, 2026
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Clinical Outcomes Following Discordance Between Fractional Flow Reserve and Instantaneous Wave-Free Ratio in Deferred
Spyridon Graidis1, Filippos Timpilis2, Georgia Xygka1
1Cardiology Division, University Hospital of Patras, 26504 Rio, Greece.
Background:
Current guidelines recommend the use of either fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) for assessing intermediate coronary stenoses. However, FFR/iFR discordance occurs in approximately 20% of cases. This systematic review and meta-analysis aimed to investigate whether deferring lesions with discordant FFR/iFR classification is associated with worse prognosis compared to those with negative concordant results (FFR-/iFR-).
Methods:
A systematic search was conducted in literature repositories to identify all studies that compared the clinical prognosis of deferred lesions with discordant and concordant FFR/iFR results. The primary endpoint was a composite clinical outcome of the individual secondary endpoints (death, myocardial infarction, and revascularization).
Results:
Three eligible observational studies (1735 deferred vessels) were included in the meta-analysis. Overall, deferred lesions with FFR/iFR discordance presented numerically higher event rates for all primary and secondary endpoints compared to deferred lesions with negative concordance; however, none reached statistical significance. Deferred lesions with FFR-/iFR+ discordance were significantly associated with an increased risk of death (odds ratio [OR]: 3.19; p = 0.049), while deferred lesions with FFR+/iFR- discordance were associated with a greater risk of revascularization compared to deferred lesions with negative concordance (OR: 3.24; p = 0.01).
Conclusions:
Compared to deferred lesions with negative concordant results, deferred lesions with discordant FFR/iFR results were overall not significantly associated with worse clinical outcomes; however, there was a significantly greater risk of death for deferred lesions specifically with FFR-/iFR+ discordance, and an increased risk of revascularization for deferred lesions with FFR+/iFR- discordance. Further dedicated trials are needed to improve guidance in clinical decision-making.
The Prospero Registration:
CRD420251135424, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251135424.
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