• Nasir Rahman, Ghufran Adnan, Awais Farhad, Jamshed Ali, and Ihsan Ullah.
• Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
• J Coll Physicians Surg Pak. 2021 Nov 1; 31 (11): 1263-1267.

ObjectiveTo assess the clinical outcomes of revascularisation based on fractional flow reserve (FFR) and/or instantaneous wave-free ratio (iFR).Study DesignDescriptive study.Place And Duration Of Study Department of Medicine, The Aga Khan University Hospital, Karachi from January 2012 to January 2020.Methodology A cohort of patients having moderate to severe coronary stenosis, undergoing coronary revascularisation based on invasive physiological assessment (FFR or iFR) were assessed. The participants were divided into the revascularisation-deferred group and the revascularization-performed group, based on the physiological results. Cox-proportional hazard model building was done, using a stepwise approach by assessing all plausible interactions and considering p-value ≤0.05 as statistically significant.Results The frequency of major adverse cardiac event (MACE) and target vessel revascularisation was 8.4% and 3.2% in the revascularisation-performed group as compared to 6.4% and 3.2% in the revascularisation-deferred group. In adjusted models, no statistically significant difference was noted in MACE when comparing the revascularisation-performed group with a deferred group.Conclusion Revascularisation guided by invasive physiological assessment with FFR or iFR is clinically safe and led to better resource utilisation. Key Words: Fractional flow reserve, Instantaneous wave-free ratio, Invasive physiological assessment, Low-middle income country.

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