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July 20, 2023
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Instantaneous Wave-Free Ratio for the Assessment of Intermediate Left Main Coronary Artery Stenosis: Correlations With Fractional Flow Reserve/Intravascular Ultrasound and Prognostic Implications: The iLITRO-EPIC07 Study

Publicated to:Circulation-Cardiovascular Interventions. 15 (11): 861-871 - 2022-11-01 15(11), DOI: 10.1161/CIRCINTERVENTIONS.122.012328

Authors: Rodriguez-Leor, Oriol; de la Torre Hernandez, Jose Maria; Garcia-Camarero, Tamara; Garcia del Blanco, Bruno; Lopez-Palop, Ramon; Fernandez-Nofrerias, Eduard; Cuellas Ramon, Carlos; Jimenez-Kockar, Marcelo; Jimenez-Mazuecos, Jesus; Fernandez Salinas, Francisco; Gomez-Lara, Josep; Brugaletta, Salvatore; Alfonso, Fernando; Palma, Ricardo; Gomez-Menchero, Antonio E.; Millan, Raul; Tejada Ponce, David; Linares Vicente, Jose Antonio; Ojeda, Soledad; Pinar, Eduardo; Fernandez-Pelegrina, Estefania; Morales-Ponce, Francisco J.; Cid-alvarez, Ana Belen; Rama-Merchan, Juan Carlos; Molina Navarro, Eduardo; Escaned, Javier; Perez de Prado, Armando;

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Abstract

There is little information available on agreement between fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in left main coronary artery (LMCA) intermediate stenosis. Besides, several meta-analyses support the use of FFR to guide LMCA revascularization, but limited information is available on iFR in this setting. Our aims were to establish the concordance between FFR and iFR in intermediate LMCA lesions, to evaluate with intravascular ultrasound (IVUS) in cases of FFR/iFR discordance, and to prospectively validate the safety of deferring revascularization based on a hybrid decision-making strategy combining iFR and IVUS.Prospective, observational, multicenter registry with 300 consecutive patients with intermediate LMCA stenosis who underwent FFR and iFR and, in case of discordance, IVUS and minimal lumen area measurements. Primary clinical end point was a composite of cardiovascular death, LMCA lesion-related nonfatal myocardial infarction, or unplanned LMCA revascularization.FFR and iFR had an agreement of 80% (both positive in 67 and both negative in 167 patients); in case of disagreement (31 FFR+/iFR- and 29 FFR-/iFR+) minimal lumen area was ≥6 mm2 in 8.7% of patients with FFR+ and 14.6% with iFR+. Among the 300 patients, 105 (35%) underwent revascularization and 181 (60%) were deferred according to iFR and IVUS. At a median follow-up of 20 months, major adverse cardiac events incidence was 8.3% in the defer group and 13.3% in the revascularization group (hazard ratio, 0.71 [95% CI 0.30-1.72]; P=0.45).In patients with intermediate LMCA stenosis, a physiology-guided treatment decision is feasible either with FFR or iFR with moderate concordance between both indices. In case of disagreement, the use of IVUS may be useful to indicate revascularization. Deferral of revascularization based on iFR appears to be safe in terms of major adverse cardiac events.URL: https://www.gov; Unique identifier: NCT03767621.

Keywords

coronary artery diseaseleft main coronary artery diseaseUltrasound imaging

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Circulation-Cardiovascular Interventions due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Cardiology and Cardiovascular Medicine. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 9.09, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Aug 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-08-03, the following number of citations:

  • WoS: 3

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-08-03:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 30.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 32 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 70.5.
  • The number of mentions on the social network X (formerly Twitter): 101 (Altmetric).
  • The number of mentions in news outlets: 1 (Altmetric).