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Efficacy of Fractional Flow Reserve-Guided Percutaneous Cornary Intervention for Patients with Angina Pectoris

Hiroki Shinohara1, Satoshi Kodera1, Arihiro Kiyosue1

  • 1Department of Cardiovascular Medicine, The University of Tokyo Hospital.

International Heart Journal
|November 16, 2020
PubMed

Insights

Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) did not significantly improve all-cause mortality for angina pectoris (AP). However, FFR-guided PCI reduced the composite of mortality and myocardial infarction compared to non-FFR-guided PCI and medical treatment.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Health Outcomes Research

Background:

  • Fractional flow reserve (FFR) evaluation is recommended before percutaneous coronary intervention (PCI) for angina pectoris (AP).
  • The prognostic benefit of FFR-guided PCI over other treatments remains incompletely established.
  • This network meta-analysis (NMA) aimed to clarify the comparative effectiveness of FFR-guided PCI.

Purpose of the Study:

  • To compare the clinical outcomes of FFR-guided PCI versus non-FFR-guided PCI, coronary artery bypass grafting (CABG), and medical treatment (MT) for patients with AP.
  • To assess the impact of FFR-guided PCI on all-cause mortality and a composite of mortality and myocardial infarction.

Main Methods:

  • A systematic literature search was conducted across multiple databases for studies published between 2000 and 2018.
  • A network meta-analysis (NMA) was performed on 15 randomized controlled trials (RCTs) involving 18,093 patients.
  • Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated to compare treatment outcomes.

Main Results:

  • FFR-guided PCI showed no significant difference in all-cause mortality compared to CABG, non-FFR-guided PCI, or MT.
  • For the composite outcome of all-cause mortality and myocardial infarction (12 RCTs, 15,454 patients), FFR-guided PCI significantly reduced the risk compared to non-FFR-guided PCI (OR, 0.66; 95% CI, 0.46-0.95) and MT (OR, 0.66; 95% CI, 0.46-0.95).
  • No evidence of inconsistency was found among the included studies.

Conclusions:

  • While FFR-guided PCI did not demonstrate a significant improvement in overall prognosis compared to non-FFR-guided PCI, CABG, or MT, it offers a potential benefit.
  • FFR-guided PCI may significantly reduce the combined endpoint of all-cause mortality and myocardial infarction when compared to non-FFR-guided PCI and MT.
  • Further research may be warranted to fully elucidate the long-term prognostic advantages of FFR implementation in routine clinical practice.

Keywords:
Coronary artery diseaseMyocardial revascularizationSurvival rateTreatment outcome

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