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Updated: May 13, 2026
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Systematic review and meta-analysis of randomized and nonrandomized studies on fractional flow reserve-guided
Fabio Mangiacapra1, Luca Paolucci1, Nils P Johnson2
1Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Insights
Fractional flow reserve (FFR)-guided revascularization reduced death, heart attacks, and major adverse cardiovascular events (MACE). However, benefits were less clear in studies with high revascularization rates or acute coronary syndrome prevalence.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Conflicting results exist regarding the effectiveness of fractional flow reserve (FFR) in guiding myocardial revascularization.
- Previous studies have yielded inconsistent findings on whether FFR guidance improves patient outcomes compared to standard angiography.
Purpose of the Study:
- To compare clinical outcomes between FFR-guided and angiography-guided revascularization in patients with coronary artery disease.
- To synthesize evidence from randomized controlled trials (RCTs) and nonrandomized studies to clarify the role of FFR in revascularization.
Main Methods:
- A systematic review and meta-analysis including RCTs and nonrandomized intervention studies.
- Coprimary endpoints included all-cause death, myocardial infarction, and major adverse cardiovascular events (MACE).
- Study registered with PROSPERO (CRD42022344765).
Main Results:
- 30 studies with 393,588 patients were analyzed.
- FFR guidance was associated with significantly lower rates of all-cause death, myocardial infarction, and MACE.
- No significant differences were observed in RCTs alone, but FFR use reduced revascularizations and treated lesions.
Conclusions:
- FFR-guided revascularization shows potential for improved outcomes, but data from RCTs and nonrandomized studies present conflicting evidence.
- The benefits of FFR guidance appear diminished in patient groups with high revascularization rates or a high prevalence of acute coronary syndromes.
- Further research may be needed to define optimal patient selection for FFR-guided revascularization.
Introduction And Objectives:
Several studies have investigated the effectiveness of fractional flow reserve (FFR) guidance in improving clinical outcomes after myocardial revascularization, yielding conflicting results. The aim of this study was to compare clinical outcomes in patients with coronary artery disease following FFR-guided or angiography-guided revascularization.
Methods:
Both randomized controlled trials (RCTs) and nonrandomized intervention studies were included. Coprimary endpoints were all-cause death, myocardial infarction, and major adverse cardiovascular events (MACE). The study is registered with PROSPERO (CRD42022344765).
Results:
A total of 30 studies enrolling 393 588 patients were included. FFR-guided revascularization was associated with significantly lower rates of all-cause death (OR, 0.63; 95%CI, 0.53-0.73), myocardial infarction (OR, 0.70; 95%CI, 0.59-0.84), and MACE (OR, 0.77; 95%CI, 0.70-0.85). When only RCTs were considered, no significant difference between the 2 strategies was observed for any endpoints. However, the use of FFR was associated with reduced rates of revascularizations and treated lesions. Metaregression suggested that the higher the rate of revascularized patients the lower the benefit of FFR guidance on MACE reduction compared with angiography guidance (P=.012). Similarly, higher rates of patients with acute coronary syndromes were associated with a lower benefit of FFR-guided revascularization (P=.039).
Conclusions:
FFR-guided revascularization was associated with lower rates of all-cause death, myocardial infarction and MACE compared with angiographic guidance, with RCTs and nonrandomized intervention studies yielding conflicting data. The benefits of FFR-guidance seem to be less evident in studies with high revascularization rates and with a high prevalence of patients with acute coronary syndrome.
