Guide PCI with coronary physiology

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Final CEE consent

Are you using physiology?

Yes

No

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

DEFINE PCI:

Unseen focal lesions cause residual ischemia

The DEFINE PCI study used iFR pullback to understand the rate and causes of residual ischemia in 500 patients undergoing contemporary PCI. Early results find that residual ischemia is common, and causes are treatable.¹³

Angiographically focal stenosis defined as ≤ 15 mm.¹³

DEFINE PCI – experts discuss the key finding

Allen Jeremias discusses: DEFINE PCI

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 .

FFR = Distal Coronary Pressure (Pd)

Promixal Coronary Pressure (Pa)

(During maximal hyperemia)

iFR = Distal Coronary Pressure (Pd)

Promixal Coronary Pressure (Pa)

(During wave-free period)

Find out more about iFR and 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 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.

Proven outcomes

Validated in more than 4,500 patients^9,10
Consistent outcomes as with FFR
0.89 cut-point backed by data^9,10,12

Watch our clinical experts talk about iFR cost effectiveness

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

Calculate your cost saving with iFR

More information

Be sure with iFR guidance

In-depth information for lesion specific ischemia

The Cardiovascular Center of Catania prefers to use iFR over FFR, for its savings on time, contrast and stents. They are frequent users of iFR Scout and iFR Co-Registration.

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)

Discover iFR Scout (2.06MB)

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

Discover SyncVision

Watch a case study on the LAD with diffuse disease

Davide Capodanno MD and Alessio La Manna MD, practicing interventional cardiologists at University of Catania explain the advantages of iFR Co-Registration to optimally treat diffuse disease in the LAD.

LAD deferral is safer with iFR

Sen etal . (2019, JACC), Deferral of LAD revascularization based on iFR appears to be safe and is associated with 53% lower MACE rates when compared against FFR.

Get more details here

“In this study, we have clearly demonstrated that it is safe to defer on the basis of iFR. If I see a patient with an LAD lesion, I'm only reassured for medical therapy if the iFR is negative.”

Dr. Sayan Sen, Consultant Cardiologist, Hammersmith Hospital & Imperial College London, discusses details of the LAD sub-study of DEFINE-FLAIR

Study aims

iFR and FFR results

Value of iFR and Co-registration

Explore our solutions and products across the care continuum

SyncVision

The SyncVision precision guidance system is suitable with IntraSight and Core Integrated interventional platforms and streamlines lesion assessment, simplifies vessel sizing and enables precise therapy delivery all while integrating seamlessly in daily workflows in interventional suites of choice.

IGTDSYNC

ดูผลิตภัณฑ์
Verrata Plus

For over 20 years Philips has led the way in physiology, putting patients first through continuous innovation. Experience our 10ᵗʰ generation physiology wire: Verrata Plus.

989604186571

ดูผลิตภัณฑ์
Core

The Core precision guided therapy systems offer the choice of imaging and physiology on a single integrated platform.¹ Core helps provide clarity in your approach, confidence in your decisions, and convenience in your diagnostic and interventional workflows.

IGTDCORE

ดูผลิตภัณฑ์
Core Mobile

Core Mobile is designed to power the future of precision guided therapy and offers the choice of imaging and physiology on a single mobile platform.¹ Core Mobile also provides clarity in your approach and confidence in your results by offering additional information during the diagnostic phase, assisting in intervention decisions.

IGTDCOREM

ดูผลิตภัณฑ์

Discover our entire IGT Devices Portfolio

References

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.
Zir LM et al. Interobserver variability in coronary angiography. Circulation. 1976;53:627–632.
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.
Cameron A et al. Left main coronary artery stenosis: angiographic determination. Circulation. 1983;68:484–489.
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.
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.
De Bruyne B, Sarma J, Heart. 2008;94(7):949-59.
Neumann, F.-J. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European heart journal (2018).
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
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
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.
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