Role of Instantaneous Wave-Free Ratio in Detection of Residual Significant Ischemia after Successful Angiographic Percutaneous Coronary Intervention

Elsayed, Amr A.; Abdelsalam, Hany E.; Alrabat, Khalid E.; Taha, Mohamed O.; Nasr, Hesham A.; Sabry, Al-Shimaa M.

doi:10.21608/bmfj.2025.399474.2511

Role of Instantaneous Wave-Free Ratio in Detection of Residual Significant Ischemia after Successful Angiographic Percutaneous Coronary Intervention

Articles in Press

Document Type : Original Article

Authors

¹ Cardiovascular Medicine, Faculty of Medicine, Benha University, Benha, Egypt

² Consultant of Cardiology, National Heart Institute, Cairo, Egypt

³ Cardiovascular Medicine, Faculty of Medicine, Benha University,

10.21608/bmfj.2025.399474.2511

Abstract

Background: Despite angiographic success after PCI, a substantial proportion of cases experience residual ischemia (RI), contributing to adverse outcomes. Instantaneous wave-free ratio (iFR) offers a practical, vasodilator-free method to assess post-PCI functional results. This study aimed to estimate the prevalence, predictors, and clinical implications of RI (iFR ≤ 0.89) following angiographically successful PCI. Methods: This prospective investigation encompassed 100 hemodynamically stable CAD cases who underwent angiographically successful PCI. Post-PCI iFR was measured. Cases were stratified by iFR into RI (≤ 0.89) (n=28) and non-ischemic (> 0.89) (n=62) groups. Clinical and angiographic characteristics were compared. One-year MACEs were tracked. Results: RI was detected in 28% of cases. These cases were significantly older (67 ± 10 vs. 61 ± 9 years, P = 0.009), had elevated BMI (30 ± 4 vs. 28 ± 3 kg/m², P = 0.024), and more CKD (35.7% vs. 12.5%, P = 0.012). They also had more severe stenosis (79 ± 5% vs. 68 ± 7%, P < 0.001), longer lesions (28 mm vs. 17 mm, P < 0.001), and more calcifications (60.7% vs. 37.5%, P = 0.036). Kaplan-Meier analysis showed substantially higher 1-year MACE in the ischemic group (16.6% vs. 0%, log-rank P < 0.001; HR = 38.14, 95% CI: 10.01–145.39). Conclusion: RI post-angiographically successful PCI is not uncommon and is associated with specific clinical and lesion-related predictors and worse clinical outcomes. Post-PCI iFR assessment may uncover functionally suboptimal results that merit further optimization.

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