Fractional flow reserve versus angiography for guiding percutaneous coronary intervention: a meta-analysis

Dongfeng Zhang, Shuzheng Lv, Xiantao Song, Fei Yuan, Feng Xu, Min Zhang, Shuai Yan, Xingmei Cao, Dongfeng Zhang, Shuzheng Lv, Xiantao Song, Fei Yuan, Feng Xu, Min Zhang, Shuai Yan, Xingmei Cao

Abstract

Objectives: The purpose of this study was to investigate whether fractional flow reserve (FFR) should be performed for patients with coronary artery disease (CAD) to guide the percutaneous coronary intervention (PCI) strategy.

Background: PCI is the most effective method to improve the outcomes of CAD. However, the proper usage of PCI has not been achieved in clinical practice.

Methods: A meta-analysis was performed on angiography-guided PCI and FFR-guided PCI strategies. Prospective and retrospective studies were included when research subjects were patients with CAD undergoing PCI. The primary endpoint was the rate of major adverse cardiac events (MACE) or major adverse cardiac and cerebrovascular events (MACCE). Secondary endpoints included death, myocardial infarction (MI), repeat revascularisation and death or MI.

Results: Four prospective and three retrospective studies involving 49 517 patients were included. Absolute risks of MACE/MACCE, death, MI, revascularisation and death or MI for angiography-guided PCI and FFR-guided PCI were 34.8% vs 22.5%, 15.3% vs 7.6%, 8.1% vs 4.2%, 20.4% vs 14.8%, and 21.9% vs 11.8%, respectively. The meta-analysis demonstrated that FFR-guided PCI was associated with lower MACE/MACCE (OR: 1.71, 95% CI 1.31 to 2.23), death (OR: 1.64, 95% CI 1.37 to 1.96), MI (OR: 2.05, 95% CI 1.61 to 2.60), repeat revascularisation (OR: 1.25, 95% CI 1.09 to 1.44), and death or MI (OR: 1.84, 95% CI 1.58 to 2.15) than angiography-guided PCI strategy.

Conclusions: This meta-analysis supports current guidelines advising the FFR-guided PCI strategy for CAD. PCI should only be performed when haemodynamic significance is found.

Keywords: CORONARY ARTERY DISEASE; INTERVENTIONAL CARDIOLOGY.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Flow diagram of study inclusion and exclusion criteria.
Figure 2
Figure 2
Angiography-guided percutaneous coronary intervention (PCI) versus fractional flow reserve-guided PCI major adverse cardiac events/major adverse cardiac and cerebrovascular events.
Figure 3
Figure 3
Angiography-guided percutaneous coronary intervention (PCI) versus fractional flow reserve-guided PCI death.
Figure 4
Figure 4
Angiography-guided percutaneous coronary intervention (PCI) versus fractional flow reserve-guided PCI myocardial infarction.
Figure 5
Figure 5
Angiography-guided percutaneous coronary intervention (PCI) versus fractional flow reserve-guided PCI repeat revascularisation.
Figure 6
Figure 6
Angiography-guided percutaneous coronary intervention (PCI) versus fractional flow reserve-guided PCI death or myocardial infarction.

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