Physiology

    Guide PCI with coronary physiology

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    Are you using physiology?

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    iFR is now recommended by the European Society of Cardiology (ESC)guidelines 8

    Recommendations
    Class
    Level
    iFR/FFR to identify hemodynamically relevant coronary lesion(s) in stable patients when evidence of ischemia is not available
    I
    A
    FFR-guided PCI in patients with multivessel disease.
    IIa
    B
    Single intermediate lesions
    Diffuse disease
    Bifurcation lesions
    Serial or Tandem lesions
    Multi-Vessel disease (MVD)
    Post-PCI assessment
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    "The Inclusion of iFR in the guidelines is extremely important as it will increase awareness and help adoption of physiology"

     

    Prof. Giuseppe Tarantini
    Department of Cardiac, Thoracic and Vascular Sciences, University of Pudua

     

    The power of choice

     

    Philips provides you with the opportunity to use iFR which is the only clinically validated resting index (recommended by AHA and SCAI) along with FFR. In 2017 Davies et al. and Götberg et al. validated the non-inferiority of iFR compared to FFR .

    coronary pressure

    FFR = Distal Coronary Pressure (Pd)

    Promixal Coronary Pressure (Pa)

    (During maximal hyperemia)

    Distal Coronary Pressure

    iFR = Distal Coronary Pressure (Pd)

    Promixal Coronary Pressure (Pa)

    (During wave-free period)

    FFR

    FFR

    A physiology index to determine the functional significance of coronary stenosis. FFR is the ratio of the distal pressure compared to the proximal pressure during maximal blood flow (hyperemia), which can be induced by injecting products such as adenosine or papaverine.

    iFR

    iFR

    iFR provides a hyperemia-free measurement in as few as five heartbeats. Pressure and flow correlate when resistance is consistant P = Q * R. iFR is measured during the wave-free period when resistance is naturally constant.

    Diagram treat and defer

    Proven outcomes

     

    • Validated in more than 4,500 patients9,10
    • Consistent outcomes as with FFR
    • 0.89 cut-point backed by data9,10,12
    europcr 2018 web graphics char

    Superior value

     

    • 10% Cost saving per patient11
    • 10% reduction in procedure time
    • 90% reduction in patient discomfort9
  • 10% Cost saving per patient
  • 10% reduction in procedure time
  • 90% reduction in patient discomfort1
  • 10% Cost saving per patient
  • 10% reduction in procedure time
  • 90% reduction in patient discomfort1
  • europcr 2018 web graphics cluster

    Be sure with iFR Guidance

    In-depth information for lesion specific ischemia
    ifr scout

    iFR Scout

     

    • Provides beat-by-beat pressure measurements across the entire vessel, artery by artery
    • Establishes the physiological significance of each vessel and/or individual lesion (focal or diffuse)
    • Provides a clear view of the functional gain from treating
    • Facilitates multiple assessments before, during and after the procedure (without the need for hyperemia)
    ifr co reg

    iFR Co-Registration

     

    • Visualization of pressure gradients to facilitate stent planning on SyncVision system
    • Provides mapping of physiology information into the anatomy image
    • Allows length measurement to be made on to the angiogram
    • Seamless integration into your PCI
    • Provides iFR estimated value post-stenting allowing for virtual stenting functionality

    References

    1. Curzen N, et al. Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain?: the RIPCORD study. Circ Cardiovasc Interv. 2014. Apr;7(2):248-55. doi:10.1161/ CIRCINTERVENTIONS.113.000978.
    2. Zir LM et al. Interobserver variability in coronary angiography. Circulation. 1976;53:627–632.
    3. Leape L et al. Effect of variability in the interpretation of coronary angiograms on the appropriateness of use of coronary revascularisation procedures. Am Heart J. 2000;139:106–113.
    4. Cameron A et al. Left main coronary artery stenosis: angiographic determination. Circulation. 1983;68:484–489.
    5. Van Belle E, et al. Outcome impact of coronary revascularization strategy reclassification with fractional flow reserve at time of diagnostic angiography: insights from a large French multicenter fractional flow reserve registry. Circulation. 2014;129(2):173–185. doi:10.1161/ CIRCULATIONAHA.113.006646.
    6. Baptista S.B, et al. the POST-IT (POrtuguese Study on The Evaluation of FFR-guided Treatment of coronary disease) prospective multicentre registry. Abstract presented at late-breaking clinical trial session at EuroPCR 2014.
    7. De Bruyne B, Sarma J, Heart. 2008;94(7):949-59.
    8. Neumann, F.-J. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European heart journal (2018).
    9. Davies JE, et al., DEFINE-FLAIR: A Multi- Centre, Prospective, International, Randomized, Blinded Comparison of Clinical Outcomes and Cost Efficiencies of iFR and FFR Decision-Making for Physiological Guided Coronary Revascularization. New England Journal of Medicine, epub March 18, 2017
    10. Gotberg M, et al., Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve Guided Intervention (IFR-SWEDEHEART): A Multicenter, Prospective, Registry-Based Randomized Clinical Trial. New England Journal of Medicine, epub March 18, 2017
    11. Patel M. “Cost-effectiveness of instantaneous wave-Free Ratio (iFR) compared with Fractional Flow Reserve (FFR) to guide coronary revascularization decision-making.” Late-breaking Clinical Trial presentation at ACC on March 10, 2018.  
    12. An iFR cut-point of 0.89 matches best with an FFR ischemic cut-point of 0.80 with a specificity of 87.8% and sensitivity of 73.0%. (From ADVISE II, and iFR Operator’s Manual 505-0101.23