Fractional flow reserve in acute coronary syndrome: a meta-analysis and systematic review

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• The role of Fractional Flow Reserve (FFR) in guiding revascularisation for Acute Coronary Syndrome (ACS) requires further clarification.
• Current evidence is insufficient to definitively establish FFR's utility in managing ACS patients.

Purpose of the Study:

• To compare clinical outcomes between ACS and Stable Angina (SA) patients undergoing FFR-guided revascularisation.
• To specifically evaluate the safety of deferring revascularisation in ACS patients based on FFR results.

Main Methods:

• A comprehensive meta-analysis of existing medical literature was conducted.
• Included studies compared clinical outcomes such as Major Adverse Cardiovascular Events (MACE), myocardial infarction (MI), mortality, and revascularisation rates.
• Analyzed data from 9 studies encompassing 5457 patients, identified from 937 records.

Main Results:

• Patients with ACS experienced significantly higher rates of recurrent MI (OR 1.81, p=0.02) and showed trends towards increased MACE and mortality compared to SA patients under FFR-guided strategies.
• Deferring revascularisation in ACS patients based on FFR resulted in higher rates of MACE (17.6% vs 7.3%), recurrent MI (5.3% vs 1.5%), and target vessel revascularisation (16.4% vs 5.6%) compared to SA.
• A trend towards higher cardiovascular mortality was observed in ACS patients with deferred treatment.

Conclusions:

• FFR-guided revascularisation strategies are associated with higher adverse event rates in ACS patients than in SA patients.
• Deferring invasive treatment based on current FFR thresholds appears less safe for ACS patients compared to SA patients.
• There is a critical need to refine therapeutic approaches for ACS patients with multivessel disease to improve outcomes.