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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT02053038
Registration number
NCT02053038
Ethics application status
Date submitted
26/11/2013
Date registered
3/02/2014
Date last updated
14/08/2019
Titles & IDs
Public title
Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation
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Scientific title
Prospective, Multi-center, Double Blind, Randomised Study to Test the Safety of Deferral of Stenting in Physiological Non-significant Lesions in a Clinical Population of Intermediate Stenoses Using iFR and FFR
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Secondary ID [1]
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13SM1797
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Universal Trial Number (UTN)
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Trial acronym
DEFINE-FLAIR
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Coronary Artery Disease
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Condition category
Condition code
Cardiovascular
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Coronary heart disease
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Devices - iFR
Treatment: Devices - FFR
Experimental: iFR - Treatment guided by iFR
Active comparator: FFR - Treatment guided by FFR
Treatment: Devices: iFR
Treatment guided by instantaneous wave-free ratio
Treatment: Devices: FFR
Treatment guided by Fractional Flow Reserve
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Intervention code [1]
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Treatment: Devices
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Major Adverse Cardiac Events
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Assessment method [1]
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Composite of death, myocardial infarction, unplanned revascularisation
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Timepoint [1]
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30 days, 1, 2 and 5 years
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Secondary outcome [1]
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Death (all cause)
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Assessment method [1]
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30 days, 1, 2 and 5 years
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Secondary outcome [2]
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Death (cardiovascular)
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Assessment method [2]
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Timepoint [2]
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30 days, 1, 2 and 5 years
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Secondary outcome [3]
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Myocardial Infarction
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Assessment method [3]
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Timepoint [3]
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30 days, 1, 2 and 5 years
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Secondary outcome [4]
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Repeat revascularisation
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Assessment method [4]
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Timepoint [4]
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30 days, 1, 2 and 5 years
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Secondary outcome [5]
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Cost associated to iFR or FFR measurement
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Assessment method [5]
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Cost associated to iFR or FFR
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Timepoint [5]
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30 days, 1, 2 and 5 years
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Secondary outcome [6]
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Quality of life assessed by EQ-5D-5L and Seattle Angina Questionnaire
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Assessment method [6]
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Timepoint [6]
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30 days, 1, 2 and 5 years
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Secondary outcome [7]
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Cost savings of removing secondary investigations
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Assessment method [7]
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7) Cost savings of removing secondary investigations, by assessing/treating non-culprit acute coronary syndrome (ACS) at the time of index presentation.
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Timepoint [7]
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30 days, 1, 2 and 5 years
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Eligibility
Key inclusion criteria
1. Age > 18 years of age
2. Willing to participate and able to understand, read and sign the informed consent document before the planned procedure
3. Eligible for coronary angiography and/or percutaneous coronary intervention
4. Coronary artery disease with at least 1 or more native major epicardial vessels or their branches by coronary angiogram with visually assessed de novo coronary stenosis in which the physiological severity of the lesion is in question (typically 40-70% diameter stenosis).
5. Stable angina or acute coronary syndrome (non-culprit vessels only and outside of primary intervention during acute STEMI)
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Minimum age
18
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Maximum age
90
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Exclusion criteria:
1. Previous Coronary Artery Bypass surgery with patent grafts to the interrogated vessel
2. Significant left main stenosis (>50% narrowing)
3. Tandem stenoses separated by more than 10 mm that require separate pressure guide wire interrogation or percutaneous coronary intervention (PCI) (not to be interrogated or treated as a single stenosis)
4. Total coronary occlusions (CTOs). NOTE: Patients with CTOs can be included if i) treatment of the CTO is completed first, ii) the CTO PCI is successful, iii) the CTO PCI is successful and iii) the physiological lesion is in another vessel
5. Restenotic lesions
6. Hemodynamic instability at the time of intervention (heart rate<50 beats per minute, systolic blood pressure <90mmHg), balloon pump
7. Significant contraindication to adenosine administration (e.g. heart block, severe asthma)
8. Contraindications to PCI (percutaneous coronary intervention) or drug-eluting stent (DES) implantation
9. Heavily calcified or tortuous vessels
10. Significant hepatic or lung disease (chronic pulmonary obstructive disease), and/or malignant disease with unfavourable prognosis that may influence survival within the next 5 years
11. Pregnancy
12. STEMI (ST elevation myocardial infarction) within 48 hours of procedure
13. Severe valvular heart disease
14. ACS patients in whom more than one target vessel is present
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Study design
Purpose of the study
Diagnosis
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people assessing the outcomes
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Intervention assignment
Parallel
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
UNKNOWN
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
1/01/2014
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
19/01/2021
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Actual
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Sample size
Target
2500
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Recruitment hospital [1]
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Sam Lehman - Adelaide
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Recruitment hospital [2]
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Darren Walters - Brisbane
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James Sapontis - Melbourne
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Recruitment hospital [4]
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Ravinay Bhindi - Sydney
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- Adelaide
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- Brisbane
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- Melbourne
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Recruitment postcode(s) [4]
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- Sydney
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Recruitment outside Australia
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United States of America
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California
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Colorado
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Georgia
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Missouri
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North Carolina
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Antwerp
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Belgium
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Bonheiden
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Egypt
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Cairo
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Finland
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Helsinki
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Germany
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Berlin
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Germany
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Koblenz
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Germany
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Oldenburg
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Italy
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Catanzaro
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Italy
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Rome
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Italy
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Verona
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Aichi
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Japan
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Fukuoka
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Japan
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Fukuyama
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Gifu
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Tokyo
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Daegu
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Ulsan
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Riga
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Amsterdam
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Breda
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Portugal
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Almada
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Portugal
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Amadora
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Portugal
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Lisbon
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Riyadh
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Johannesburg
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Barcelona
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Spain
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Madrid
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Turkey
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Istanbul
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United Kingdom
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Basildon
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Bournemouth
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Exeter
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United Kingdom
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London
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United Kingdom
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Oxford
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United Kingdom
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St Leonards
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Funding & Sponsors
Primary sponsor type
Other
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Name
Imperial College London
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Ethics approval
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Summary
Brief summary
Narrowing of coronary arteries interferes with blood flow and can cause chest pain. But patients may have more than one narrowing and studies have shown that not all narrowings need to be treated. To identify the narrowings that need treating cardiologists sometimes quantify the extent of the narrowing by measuring fractional flow reserve (FFR, the ratio of the pressure in the aorta to the pressure downstream of the narrowing).This technique requires the administration of drugs that add cost and time to the procedure and in some countries are simply unavailable. As a result despite the clear health and healthcare costs benefits of FFR its use is limited to less than 5% of procedure. We have developed a new technique called the instantaneous wave-free ratio (iFR) that does not require the administration of drugs for its accurate assessment. It has been approved for use in this indication. This study aims to compare clinical outcomes of patients whose treatment has been guided by iFR to those whose treatment has been guided by FFR. If iFR is found to provide the same clinical outcomes as FFR its adoption will permit the clear benefits of this approach of identifying the coronary narrowings that really need treatment to be applicable to a much larger patient population and further improve healthcare costs.
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Trial website
https://clinicaltrials.gov/study/NCT02053038
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Trial related presentations / publications
Kim CH, Koo BK, Dehbi HM, Lee JM, Doh JH, Nam CW, Shin ES, Cook CM, Al-Lamee R, Petraco R, Sen S, Malik IS, Nijjer SS, Mejia-Renteria H, Alegria-Barrero E, Alghamdi A, Altman J, Baptista SB, Bhindi R, Bojara W, Brugaletta S, Silva PC, Di Mario C, Erglis A, Gerber RT, Going O, Harle T, Hellig F, Indolfi C, Janssens L, Jeremias A, Kharbanda RK, Khashaba A, Kikuta Y, Krackhardt F, Laine M, Lehman SJ, Matsuo H, Meuwissen M, Niccoli G, Piek JJ, Ribichini F, Samady H, Sapontis J, Seto AH, Sezer M, Sharp ASP, Singh J, Takashima H, Talwar S, Tanaka N, Tang K, Van Belle E, van Royen N, Vinhas H, Vrints CJ, Walters D, Yokoi H, Samuels B, Buller C, Patel MR, Serruys PW, Escaned J, Davies JE. Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve-Guided Revascularization Strategy. JACC Cardiovasc Interv. 2019 Oct 28;12(20):2035-2046. doi: 10.1016/j.jcin.2019.06.035. DEFINE-FLAIR Trial Investigators; Lee JM, Choi KH, Koo BK, Dehbi HM, Doh JH, Nam CW, Shin ES, Cook CM, Al-Lamee R, Petraco R, Sen S, Malik IS, Nijjer SS, Mejia-Renteria H, Alegria-Barrero E, Alghamdi A, Altman J, Baptista SB, Bhindi R, Bojara W, Brugaletta S, Silva PC, Di Mario C, Erglis A, Gerber RT, Going O, Harle T, Hellig F, Indolfi C, Janssens L, Jeremias A, Kharbanda RK, Khashaba A, Kikuta Y, Krackhardt F, Laine M, Lehman SJ, Matsuo H, Meuwissen M, Niccoli G, Piek JJ, Ribichini F, Samady H, Sapontis J, Seto AH, Sezer M, Sharp ASP, Singh J, Takashima H, Talwar S, Tanaka N, Tang K, Van Belle E, van Royen N, Vinhas H, Vrints CJ, Walters D, Yokoi H, Samuels B, Buller C, Patel MR, Serruys P, Escaned J, Davies JE. Comparison of Major Adverse Cardiac Events Between Instantaneous Wave-Free Ratio and Fractional Flow Reserve-Guided Strategy in Patients With or Without Type 2 Diabetes: A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol. 2019 Sep 1;4(9):857-864. doi: 10.1001/jamacardio.2019.2298. Davies JE, Sen S, Dehbi HM, Al-Lamee R, Petraco R, Nijjer SS, Bhindi R, Lehman SJ, Walters D, Sapontis J, Janssens L, Vrints CJ, Khashaba A, Laine M, Van Belle E, Krackhardt F, Bojara W, Going O, Harle T, Indolfi C, Niccoli G, Ribichini F, Tanaka N, Yokoi H, Takashima H, Kikuta Y, Erglis A, Vinhas H, Canas Silva P, Baptista SB, Alghamdi A, Hellig F, Koo BK, Nam CW, Shin ES, Doh JH, Brugaletta S, Alegria-Barrero E, Meuwissen M, Piek JJ, van Royen N, Sezer M, Di Mario C, Gerber RT, Malik IS, Sharp ASP, Talwar S, Tang K, Samady H, Altman J, Seto AH, Singh J, Jeremias A, Matsuo H, Kharbanda RK, Patel MR, Serruys P, Escaned J. Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI. N Engl J Med. 2017 May 11;376(19):1824-1834. doi: 10.1056/NEJMoa1700445. Epub 2017 Mar 18.
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Public notes
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Contacts
Principal investigator
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Justin ER Davies, MD
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Address
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Imperial College London
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Contact person for scientific queries
No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT02053038
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