Related Experiment Video
Updated: Sep 10, 2026
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Outcomes associated with fractional flow-guided revascularization: a meta-analysis
Anthony A Bavry1, Islam Y Elgendy, John W Petersen
1North Florida/South Georgia Veterans Health System, Gainesville, Florida; Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
Insights
Deferring treatment for non-ischemic coronary lesions is common. This meta-analysis shows deferral is safe for left main disease but associated with better outcomes in non-left main disease when ischemia is present.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- The long-term outcomes of deferring revascularization for nonischemic coronary lesions are not well-established.
- Current guidelines generally recommend deferral for lesions deemed abnormal but not causing ischemia.
Purpose of the Study:
- To evaluate the clinical outcomes of deferring revascularization in patients with coronary artery lesions.
- To compare outcomes between left main and non-left main coronary artery lesions.
Main Methods:
- A systematic meta-analysis of studies identified via PubMed search.
- Included studies reported clinical outcomes following fractional flow reserve-guided revascularization.
- Outcomes were analyzed for left main and non-left main coronary artery subgroups.
Main Results:
- 17 studies with 2975 participants were included.
- For left main disease, adverse events were similar between deferral (15.3%) and revascularization (14.3%) groups.
- For non-left main disease, deferral had significantly fewer adverse events (9.2%) compared to revascularization (18.8%) when ischemia was present.
Conclusions:
- Deferral of revascularization for left main coronary artery disease is associated with similar adverse event rates compared to revascularization.
- In non-left main coronary artery disease, deferral is linked to better outcomes when lesions are not ischemic.
Background:
Deferral of revascularization for abnormal but nonischemic lesions is usually recommended; however, the long-term outcome of this approach is not well known.
Hypothesis:
Deferral of nonischemic lesions will be associated with a low frequency of adverse events.
Methods:
A PubMed search of the MEDLINE database identified studies that reported clinical outcomes among patients who had fractional flow reserve-guided revascularization. We further categorized studies into 2 subgroups: left main and non-left main coronary artery lesions. Baseline demographics and clinical outcome data were extracted by 3 independent reviewers. Fixed and random effects summary risk ratios were constructed using Mantel-Haenszel and DerSimonian-Laird models, respectively. The primary outcome was the composite of death, myocardial infarction, and revascularization.
Results:
From 741 potential studies, 17 were included in the meta-analysis (n = 2975 participants), 8 in the left main subgroup (n = 595) and 9 studies (n = 2380) in non-left main subgroup. In the left main subgroup, the incidence of the composite outcome was 15.3% in the no-ischemia/deferral group vs 14.3% in the ischemia/revascularization group (risk ratio [RR] = 1.13, 95% confidence interval [CI]: 0.76-1.68, P = 0.54, I(2) = 3.7%). In the non-left main subgroup, the incidence of the composite outcome was 9.2% in the no-ischemia/deferral group vs 18.8% in the ischemia/revascularization group (RR = 0.42, 95% CI: 0.34-0.52, P < 0.0001, I(2) = 20.7%).
Conclusions:
Patients with left main coronary disease had a relatively high incidence of adverse cardiovascular events, which was similar in both the deferral and revascularization groups. In patients with non-left main disease, ischemia was associated with worse outcomes despite revascularization.
