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
Benha Medical Journal
Articles in Press, Accepted Manuscript, Available Online from 06 August 2025 PDF (811.04 K)
Document Type: Original Article
DOI: 10.21608/bmfj.2025.399474.2511
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Authors
Amr A. Elsayed¹; Hany E. Abdelsalam ¹; Khalid E. Alrabat¹; Mohamed O. Taha²; Hesham A. Nasr¹; Al-Shimaa M. Sabry³
¹Cardiovascular Medicine, Faculty of Medicine, Benha University, Benha, Egypt
²Consultant of Cardiology, National Heart Institute, Cairo, Egypt
³Cardiovascular Medicine, Faculty of Medicine, Benha University,
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.
Keywords
Percutaneous Coronary Intervention; Instantaneous Wave-Free Ratio; Residual Ischemia; MACE


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