Fractional-flow reserve use in coronary artery revascularization: a 78.897 patients systematic review and meta-analysis

Abstract

Abstract Background Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is recommended in the guidelines of revascularization for patients presenting with coronary artery disease (CAD) with intermediate lesion severity. However, recently published studies comparing FFR-guided PCI with non-physiology guided revascularization strategies have reported conflicting result. Methods The PubMed and Embase databases were searched for randomized clinical trials and observational studies comparing FFR-guided PCI with non-physiology-guided revascularization strategies (angiography-guided, intracoronary imaging-guided, coronary artery bypass grafting) in patients with CAD. Data were pooled by meta-analysis using a random-effects model. Results 26 studies enrolling 78,897 patients were included. Patients undergoing FFR-guided PCI as compared to those undergoing non-physiology guided coronary revascularization had a lower risk of all-cause mortality (OR 0.79 95% CI 0.64-0.99, I2=53%) and myocardial infarction (OR 0.74 95% CI 0.59-0.93, I2=44.7%). However, no differences between groups were found in terms of MACE (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%). Conclusions Among patients with CAD, FFR-guided PCI as compared to non-physiology-guided revascularization was associated with a lower risk of all-cause mortality and MI.Clinical outcomes in patients undergoingFFR-guided PCI as compared to non-physio