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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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FFR-guided versus coronary angiogram-guided CABG: A review and meta-analysis of prospective randomized controlled

Dhayan Timbadia1,2, Ashlynn Ler2,3, Faizus Sazzad2,4,5

  • 1Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Journal of Cardiac Surgery
|July 23, 2020
PubMed

Insights

Fractional flow reserve (FFR) guided coronary artery bypass graft surgery (CABG) shows no significant clinical outcome differences compared to standard coronary angiography (CAG) guided CABG. Current evidence does not support routine FFR use before CABG.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Health Outcomes Research

Background:

  • Fractional flow reserve (FFR) is established for percutaneous coronary intervention but its role in coronary artery bypass graft surgery (CABG) is unclear.
  • Comparing FFR-guided CABG with standard coronary angiography (CAG)-guided CABG is crucial for optimizing surgical decision-making.
  • Existing evidence requires synthesis to guide clinical practice regarding FFR use in CABG.

Purpose of the Study:

  • To compare clinical outcomes of FFR-guided CABG versus CAG-guided CABG.
  • To evaluate the impact of FFR assessment on graft patency rates after CABG.
  • To determine if FFR guidance offers advantages over conventional CAG guidance in CABG patients.

Main Methods:

  • A meta-analysis of prospectively randomized controlled trials (PRCTs) was conducted following PRISMA guidelines.
  • Included two PRCTs (FARGO and GRAFFITI trials) with data from 269 patients and 6-12 month follow-up.
  • Assessed primary endpoints including death, MACCE, revascularization, and myocardial infarction, and secondary endpoints of graft patency.

Main Results:

  • No significant differences were observed between FFR-guided and CAG-guided CABG groups for overall death, MACCE, target vessel revascularization, or spontaneous myocardial infarction.
  • Graft patency rates, including both arterial and venous grafts, were similar between the two groups.
  • The meta-analysis of the FARGO and GRAFFITI trials indicated comparable clinical outcomes and graft patency up to one year post-surgery.

Conclusions:

  • Current prospectively randomized controlled trials provide insufficient evidence to advocate for the routine use of FFR in CABG.
  • FFR-guided CABG and CAG-guided CABG demonstrate similar short-term clinical results and graft patency.
  • Further research may be needed to definitively establish the role, if any, of FFR in guiding CABG procedures.
Abstract

Keywords:
coronary angiographycoronary artery bypasscoronary artery diseasefractional flow reservemeta-analysis

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