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Fractional flow reserve versus angiography for guiding percutaneous coronary intervention: a meta-analysis
Dongfeng Zhang1, Shuzheng Lv1, Xiantao Song1
1Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China.
Insights
Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) significantly reduces major adverse cardiac events in coronary artery disease (CAD) patients compared to angiography guidance. FFR ensures PCI is performed only when haemodynamic significance is confirmed.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Percutaneous coronary intervention (PCI) is crucial for improving outcomes in coronary artery disease (CAD).
- Optimal application of PCI remains a challenge in clinical practice.
- Guiding PCI strategies is essential for patient management.
Purpose of the Study:
- To evaluate the efficacy of fractional flow reserve (FFR)-guided PCI versus angiography-guided PCI in patients with CAD.
- To determine if FFR guidance improves clinical outcomes and reduces adverse events.
- To inform clinical decision-making regarding PCI strategy in CAD.
Main Methods:
- A comprehensive meta-analysis of prospective and retrospective studies was conducted.
- Studies included patients with CAD undergoing PCI, comparing angiography-guided and FFR-guided strategies.
- Primary endpoint: Major Adverse Cardiac and Cerebrovascular Events (MACCE); Secondary endpoints: death, myocardial infarction (MI), and repeat revascularization.
Main Results:
- The meta-analysis included 7 studies with 49,517 patients.
- FFR-guided PCI demonstrated significantly lower rates of MACCE (22.5% vs 34.8%), death (7.6% vs 15.3%), MI (4.2% vs 8.1%), repeat revascularization (14.8% vs 20.4%), and death or MI (11.8% vs 21.9%) compared to angiography-guided PCI.
- Statistical analysis showed significant reductions in adverse events with FFR guidance (e.g., OR for MACCE: 1.71, 95% CI 1.31-2.23).
Conclusions:
- The findings support current guidelines recommending FFR-guided PCI for CAD patients.
- FFR guidance is associated with improved clinical outcomes and reduced adverse events.
- PCI should be reserved for cases where FFR confirms haemodynamic significance.
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.
