News | FFR Technologies | March 20, 2019

One in Four Patients Have Residual Ischemia Following PCI

DEFINE PCI study finds physiologic guidance tools such as iFR pullback measurements combined with Philips’ SyncVision iFR Co-registration enable physicians to precisely identify, locate and treat ischemia, offering promise to further improve PCI outcomes

One in Four Patients Have Residual Ischemia Following PCI

March 20, 2019 — At the American College of Cardiology’s (ACC) annual meeting, March 16-18 in New Orleans, Philips announced the results of the DEFINE PCI [1] study, which assessed the level of residual ischemia found in patients after percutaneous coronary interventions (PCI). This study found that 1 in 4 patients [1] treated with standard-of-care PCI left the cath lab with residual ischemia (iFR < 0.90), as demonstrated by using a blinded instantaneous wave-free ratio (iFR) pullback measurement, which is Philips’ new physiologic guidance technology.

Sponsored by Philips, the DEFINE PCI study involved approximately 500 patients, and was led by investigators from the Cardiovascular Research Foundation, Duke Clinical Research Institute and the Imperial College London.

PCI is an image-guided, minimally invasive treatment to open a coronary artery blockage (stenosis) that is causing a reduced blood flow (ischemia) to the heart tissue. Under interventional X-ray guidance (coronary angiography), clinicians navigate a balloon catheter and coronary stent to the treatment area to deploy them and restore arterial blood flow.

Several studies [2, 3] have revealed that a significant portion of patients treated with coronary stents continue to experience chest pain (angina) following PCI, leading to an increased rate of repeat procedures and corresponding higher costs. The DEFINE PCI study, which took place at centers throughout the U.S. and Europe, shows that the current approach to PCI has limitations for identifying the locations of physiologically significant arterial lesions in patients suffering from coronary artery disease (CAD). Of the patients with residual ischemia, the study showed that 81.6 percent had an untreated focal stenosis (narrowing of an artery). Further analysis of the study data showed that if all focal stenoses had been identified and successfully treated, only 1 in 20 patients would still have residual ischemia. This indicates that if the precise locations causing ischemia are better detected prior to stenting, patient outcomes may be improved.

Watch the VIDEO: iFR Equal to FFR Outcomes in Coronary Lesion Evaluation

Read the article "Easier to Use iFR Equal to Outcomes of FFR in Coronary Lesion Evaluation"

“The findings from the DEFINE PCI study reveal an opportunity for physicians to optimize procedural results and potentially help more people fully benefit from PCI,” said Allen Jeremias, M.D., principal investigator of the DEFINE PCI study.

“The fact that nearly one-quarter of patients had residual ischemia despite an angiographically successful result, mostly due to focal lesions that can easily be treated, has important implications for improving outcomes of patients undergoing stent implantation globally,” said Gregg W. Stone, M.D., professor of medicine at Columbia University Medical Center.

iFR is well-established for determining whether a vessel is indicated for treatment through the landmark DEFINE FLAIR and iFR Swedeheart outcome studies, both published in the New England Journal of Medicine [4, 5]. The one-year patient outcomes were consistent with fractional flow reserve (FFR), while iFR involved less procedural time, reduced patient discomfort and reduced cost [6]. Philips SyncVision iFR Co-registration further advances physiology by mapping the pressure profile of the whole vessel onto the angiogram, providing physiologic guidance for where to treat within the vessel. With iFR Co-registration, physicians can identify the precise locations causing ischemia, plan stent length and placement with a virtual stent, and predict physiologic improvement. Philips SyncVision with iFR Co-registration provides physicians with a full physiologic image allowing them to see clearly and treat optimally.

Read more about late-breaking trials from ACC.19

For more information:



[1] Jeremias A et al. The DEFINE PCI Trial: Blinded Physiological Assessment of Residual Ischemia after Successful Angiographic Percutaneous Coronary Intervention, presented at ACC 2019.

[2] Recurrent angina after coronary angioplasty: mechanisms, diagnostic and therapeutic options.

[3] Hakeem, A. Role of Postintervention Fractional Flow Reserve to Improve Procedural and Clinical Outcomes. Circ 2019; 139: 694-706.

[4] Davies JE, et al. Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI. N Engl J Med. 2017 May 11;376(19):1824-1834.

[5] Gotberg M, et al. iFR Swedeheart Investigators. Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI. N Engl J Med. 2017 May 11;376(19):1813-1823.

[6] 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.

[7] Tonino, et al. Fractional Flow Reserve Versus Angiography for Guiding Percutaneous Coronary Intervention. N Engl J Med. 2009;360(3):213-224.

Related Content

The American College of Cardiology (ACC) released a list of the latest practice-changing presentations at the ACC.20 annual meeting March 28-30, 2020, in Chicago. This includes five late-breaking clinical trial (LBCT) sessions and three featured clinical research sessions. There also are two LBCT deep-dive sessions where the experts will break down the hottest trials and attendees can find out what the impact might be on the practice of cardiology and patients.
Feature | ACC | April 09, 2020 | Dave Fornell, Editor
Here is the list of American College of Cardiology (ACC) practice-
ACC Cancels 2020 Conference Amid Coronavirus Concerns. #COVID19 #coronavirus #2019nCoV
Feature | ACC | March 09, 2020 | Dave Fornell, Editor
March 9, 2020 — Less than week after the American College of Cardiolog...
American College of Cardiology Names Douglas Drachman Next Annual Scientific Session Vice Chair

Image courtesy of Massachusetts General Hospital

News | ACC | October 08, 2019
Douglas Drachman, M.D., FACC, has been selected as the next vice chair of the American College of Cardiology’s (ACC)...
SyncVision iFR Co-registration from Philips Healthcare maps pressure readings onto angiogram. Results from an international study presented at ACC 2019 indicates pressure readings obtained using iFR (instantaneous wave-free ratio, also referred to as instant wave-free ratio or instant flow reserve) in coronary arteries may localize stenoses that remain after interventions. FFR in the cath lab.

SyncVision iFR Co-registration from Philips Healthcare maps pressure readings onto angiogram. Results from an international study presented at ACC 2019 indicates pressure readings obtained using iFR (instantaneous wave-free ratio, also referred to as instant wave-free ratio or instant flow reserve) in coronary arteries may localize stenoses that remain after interventions.

Feature | ACC | March 27, 2019 | Greg Freiherr, Contributing Editor
The fingerprints of value-added medicine were all over products and works-in-progress on the exhibit floor of the a

The opening late-breaking trial at ACC 2019 is the Apple Heart Study, a large-scale, app-based study to identify atrial fibrillation using a smartwatch. Earlier, smaller trials showed this approach might be used in a population health application to proactively identify AFib patients earlier.

Feature | ACC | March 19, 2019
The American College of Cardiology (ACC) released a list of the late
A patient who received HeartMate III LVAD system at ACC.18. The HeartMate 3 was the topic of of the the key late-breaking trials at #ACC18

A patient who received the HeartMate III LVAD system showing off his external battery pack. He served as a patient ambassador in the Abbott booth at ACC.18. The HeartMate III, with its magnetic levitated pump, showed a big reduction in clotting over previous LVADs in a key late-breaking trial at this year's conference.

Feature | ACC | March 27, 2018 | Dave Fornell
There were several notable presentations of new data on cardiovascular technologies at the recent 2018 American Colle
Drug Stops Dangerous Bleeding in Patients Taking Factor Xa Inhibitors


News | ACC | March 22, 2018
March 22, 2018 — The experimental drug...
Videos | ACC | March 21, 2018
DAIC Editor Dave Fornell takes a tour of some of the most interesting new technologies on the expo floor at
ACC 2018 Late-Breaking Trials Announced
News | ACC | March 21, 2018
Here is a list of the American College of Cardiology (ACC) 2018 annual meeting late-breaking clinical trials presente
Inhaled Therapy Ineffective in Difficult-to-Treat Heart Failure at ACC 2018.

Image from presentation, "Inorganic Nitrite Delivery to Improve Exercise Capacity in HFpEF: The INDIE-HFpEF Trial," Borlaug

News | ACC | March 20, 2018
March 20, 2018 — Four weeks of treatment with a novel inhaled medication failed to improve exercise capacity, daily a