Comparing the adverse clinical outcomes associated with fraction flow reserve-guided versus angiography-guided percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials.

Pravesh Kumar Bundhun,Chandra Mouli Yanamala,Feng Huang

doi:10.1186/s12872-016-0427-8

Abstract

BackgroundRecently published randomized controlled trials have shown different results compared to the Fraction Flow Reserve Versus Angiography for Multi-vessel Evaluation (FAME) study. Therefore, this current analysis aimed to compare the adverse clinical outcomes associated with Fraction Flow Reserve (FFR)-guided versus standard angiography-guided Percutaneous Coronary Intervention (PCI) using a large number of randomized patients.MethodsPubMed/Medline, EMBASE and the Cochrane library were searched for studies comparing FFR-guided with angiography-guided PCI. Mortality, Myocardial Infarction (MI), repeated revascularization and Major Adverse Cardiac Events (MACEs) at any follow up period following PCI were considered as the clinical endpoints in this analysis. Odds Ratios (OR) with 95% Confidence Intervals (CIs) were calculated and the analyses were carried out by the RevMan 5.3 software. Ethical approval was not necessary for this type of study.ResultsA total number of 2138 patients (1080 patients with FFR-guided versus 1058 patients with angiography-guided PCI) were included. Results of this analysis showed mortality not to be significantly different between FFR-guided and angiography-guided PCI with OR: 0.70, 95% CI: 0.39 – 1.25; P = 0.22, I2 = 0%. Total repeated revascularization and Target Lesion Revascularization were also similarly manifested with OR: 0.82, 95% CI: 0.60 – 1.13; P = 0.22, I2 = 0% and OR: 0.88, 95% CI: 0.43 – 1.80; P = 0.73, I2 = 0% respectively. In addition, MACEs were also not significantly lower in the FFR-guided PCI group with OR: 0.82, 95% CI: 0.64 – 1.06; P = 0.13, I2 = 0%. However, FFR-guided PCI was associated with a significantly lower rate of re-infarction with OR: 0.67, 95% CI: 0.47 – 0.96; P = 0.03, I2 = 0%.ConclusionFFR-guided PCI was not associated with significantly higher adverse clinical outcomes when compared to angiography-guided PCI. A significantly lower rate of re-infarction associated with FFR-guided PCI could show an important benefit. However, due to the limited number of patients analyzed, this hypothesis should further be confirmed in future trials.

Highlights

Published randomized controlled trials have shown different results compared to the Fraction Flow Reserve Versus Angiography for Multi-vessel Evaluation (FAME) study
The Proper Fractional Flow Reserve Criteria for Intermediate Lesions in the Era of Drug Eluting Stents (DES) (DEFFER-DES) trial showed no difference in Major Adverse Cardiac Events (MACEs) which comprised of death, Myocardial Infarction (MI) and repeated revascularization [6]
Since the benefits associated with Fraction Flow Reserve (FFR)-guided Percutaneous Coronary Intervention (PCI) showed controversial issues, we aimed to compare the adverse clinical outcomes associated with FFR-guided versus standard angiography-guided PCI using a large number of randomized patients

Summary

Introduction

Published randomized controlled trials have shown different results compared to the Fraction Flow Reserve Versus Angiography for Multi-vessel Evaluation (FAME) study. This current analysis aimed to compare the adverse clinical outcomes associated with Fraction Flow Reserve (FFR)-guided versus standard angiography-guided Percutaneous Coronary Intervention (PCI) using a large number of randomized patients. FFR is used to measure the pressure of blood flow in a stenotic artery through which, a pressure wire is used to calculate/estimate the ratio between the pressure distal to the coronary artery stenosis and pressure in the aorta, under conditions of maximum myocardial hyperemia This method could be beneficial to provide a straightforward, readily available, quantitative technique to evaluate the physiologic significance of a coronary artery stenosis [3]. The Double Kissing Crush Versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions VI (DKCRUSH-VI) showed similar clinical outcomes at one year follow up [7]

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