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Influence of fractional flow reserve on grafts patency: Systematic review and patient-level meta-analysis
Gabor G Toth1, Carlos Collet2, Anne Langhoff Thuesen3,4
1Division of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria.
Insights
Using fractional flow reserve (FFR) to guide coronary artery bypass graft surgery (CABG) is crucial. Graft failure risk is higher in vessels with non-significant stenoses, highlighting FFR
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Imaging & Diagnostics
Background:
- Fractional flow reserve (FFR) is an invasive physiological assessment used in coronary artery bypass graft surgery (CABG).
- Limited data exist on the impact of FFR-guided CABG on graft failure rates.
- This study addresses the need for comprehensive analysis of FFR's role in optimizing CABG outcomes.
Purpose of the Study:
- To investigate the impact of FFR-guided surgical intervention on graft failure in CABG.
- To determine the relationship between FFR values and the risk of graft failure post-CABG.
- To identify an FFR threshold predictive of graft failure.
Main Methods:
- A systematic review and individual patient data meta-analysis were conducted.
- Four prospective studies involving 503 patients and 1471 coronaries assessed by FFR were included.
- Graft failure risk was stratified by FFR, with analysis using random-effects and mixed-effects models.
Main Results:
- Graft failure risk was significantly higher in vessels with preserved FFR (OR 5.74).
- A decrease of 0.10 FFR units was associated with a 56% reduction in graft failure risk (OR 0.44).
- An FFR cut-off of 0.79 was identified as predictive of graft failure.
Conclusions:
- Surgical grafting of coronaries with functionally non-significant stenoses (higher FFR) is linked to increased graft failure.
- FFR guidance can help identify optimal targets for CABG, potentially reducing graft failure.
- These findings underscore the importance of physiological assessment in CABG decision-making.
Objective:
To investigate the impact of invasive functional guidance for coronary artery bypass graft surgery (CABG) on graft failure.
Background:
Data on the impact of fractional flow reserve (FFR) in guiding CABG are still limited.
Methods:
Systematic review and individual patient data meta-analysis were performed. Primary objective was the risk of graft failure, stratified by FFR. Risk estimates are reported as odds ratios (ORs) derived from the aggregated data using random-effects models. Individual patient data were analyzed using mixed effect model to assess relationship between FFR and graft failure. This meta-analysis is registered in PROSPERO (CRD42020180444).
Results:
Four prospective studies comprising 503 patients referred for CABG, with 1471 coronaries, assessed by FFR were included. Graft status was available for 1039 conduits at median of 12.0 [IQR 6.6; 12.0] months. Risk of graft failure was higher in vessels with preserved FFR (OR 5.74, 95% CI 1.71-19.29). Every 0.10 FFR units decrease in the coronaries was associated with 56% risk reduction of graft failure (OR 0.44, 95% CI 0.34 to 0.59). FFR cut-off to predict graft failure was 0.79.
Conclusion:
Surgical grafting of coronaries with functionally nonsignificant stenoses was associated with higher risk of graft failure.
