Fractional flow reserve use in coronary artery revascularization: A systematic review and meta-analysis

Jorge Sanz Sánchez; Julio I Farjat Pasos; Julia Martinez Solé; Bilal Hussain; Sant Kumar; Mohil Garg; Mauro Chiarito; Andrea Teira Calderón; Jose A Sorolla-Romero; Mauro Echavarria Pinto; Eun-Seok Shin; José Luis Diez Gil; Ron Waksman; Tim P van de Hoef; Hector M Garcia-Garcia

doi:10.1016/j.isci.2023.107245

Fractional flow reserve use in coronary artery revascularization: A systematic review and meta-analysis

iScience. 2023 Jul 3;26(8):107245. doi: 10.1016/j.isci.2023.107245. eCollection 2023 Aug 18.

Authors

Jorge Sanz Sánchez^{1

2}, Julio I Farjat Pasos³, Julia Martinez Solé¹, Bilal Hussain⁴, Sant Kumar⁵, Mohil Garg⁵, Mauro Chiarito⁶, Andrea Teira Calderón⁷, Jose A Sorolla-Romero¹, Mauro Echavarria Pinto^{8

9}, Eun-Seok Shin¹⁰, José Luis Diez Gil^{1

2}, Ron Waksman⁵, Tim P van de Hoef¹¹, Hector M Garcia-Garcia⁵

Affiliations

¹ Hospital Universitari i Politecnic La Fe, Valencia, Spain.
² Centro de Investigación Biomedica en Red (CIBERCV), Madrid, Spain.
³ Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Canada.
⁴ Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA.
⁵ MedStar Washington Hospital Center, Washington, DC, USA.
⁶ IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
⁷ Hospital Universitario Marqués de Valdecilla, Santander, Spain.
⁸ Hospital General ISSSTE Querétaro, Querétaro, México.
⁹ Universidad Autónoma de Querétaro, Querétaro, México.
¹⁰ Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
¹¹ Department of Cardiology, University Medical Center, Utrecht, the Netherlands.

Abstract

Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is recommended in revascularization guidelines for intermediate lesions. However, recent studies comparing FFR-guided PCI with non-physiology-guided revascularization have reported conflicting results. PubMed and Embase were searched for studies comparing FFR-guided PCI with non-physiology-guided revascularization strategies (angiography-guided, intracoronary imaging-guided, coronary artery bypass grafting). Data were pooled by meta-analysis using random-effects model. 26 studies enrolling 78,897 patients were included. FFR-guided PCI as compared to non-physiology-guided coronary revascularization had lower risk of all-cause mortality (odds ratio [OR] 0.79 95% confidence interval [CI] 0.64-0.99, I² = 53%) and myocardial infarction (MI) (OR 0.74 95% CI 0.59-0.93, I² = 44.7%). However, no differences between groups were found in terms of major adverse cardiac events (MACEs) (OR 0.86 95% CI 0.72-1.03, I² = 72.3%) and repeat revascularization (OR 1 95% CI 0.82-1.20, I² = 43.2%). Among patients with coronary artery disease (CAD), FFR-guided PCI as compared to non-physiology-guided revascularization was associated with a lower risk of all-cause mortality and MI.

Keywords: Cardiovascular medicine; Pathology; Surgery.