Fractional flow reserve guided versus angiographic guided surgical revascularization: A meta-analysis

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Technology Assessment

Background:

• The clinical benefits of Fraction Flow Reserve (FFR) guided Coronary Artery Bypass Grafting (CABG) require further establishment.
• Current evidence comparing FFR-guided versus angiography-guided CABG is limited.

Purpose of the Study:

• To evaluate the clinical outcomes of FFR-guided CABG compared to traditional angiography-guided CABG.
• To assess the impact of FFR guidance on Major Adverse Cardiac Events (MACE) and procedural characteristics.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies.
• Inclusion criteria encompassed studies with multivariable adjustment comparing FFR-guided and angiography-guided CABG.
• Primary endpoint was MACE; secondary endpoints included mortality, myocardial infarction, total vessel revascularization (TVR), anastomoses, on-pump procedures, and graft occlusion.

Main Results:

• Four studies (2 RCTs, 2 observational) with 983 patients were analyzed.
• No significant difference in MACE, all-cause death, myocardial infarction, or TVR between FFR-guided and angiography-guided CABG.
• FFR-guided CABG was associated with a reduction in on-pump procedures and the number of anastomoses.

Conclusions:

• FFR-guided CABG effectively reduces procedural complexity (fewer anastomoses, on-pump procedures) without compromising safety regarding MACE.
• The study did not find evidence of reduced graft occlusion with FFR-guided CABG.
• Further research may be warranted to fully elucidate long-term clinical benefits.