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Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Fractional flow reserve versus angiography-guided revascularization in coronary artery disease. Systematic review and
Mikołaj Błaziak1, Szymon Urban2, Maksym Jura1
1Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland.
Insights
Fractional flow reserve (FFR)-guided revascularization significantly reduced myocardial infarction (MI) rates compared to angiography alone. This approach also led to fewer revascularization procedures without increasing major adverse cardiovascular events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Inconsistent results from randomized controlled trials (RCTs) comparing fractional flow reserve (FFR)-guided versus angiography-guided revascularization in coronary artery disease.
- Need for clarity on FFR's role in reducing hard clinical endpoints.
Purpose of the Study:
- To assess if FFR-guided revascularization lowers rates of hard clinical endpoints compared to angiography-guided revascularization alone.
- Evaluate the impact of FFR guidance on myocardial infarction (MI) and procedural outcomes.
Main Methods:
- Systematic review and meta-analysis of RCTs published in June 2024.
- Searched Embase, Clinicaltrials.gov, Cochrane Library, and EBSCO databases.
- Included 8 RCTs with 4713 patients evaluating stable/unstable coronary artery disease and acute MI.
Main Results:
- FFR guidance significantly reduced MI rates (RR, 0.75; P = 0.02).
- FFR group had a lower rate of revascularization (SMD -0.12; P <0.0001).
- No significant differences in major adverse cardiovascular events, all-cause mortality, or unplanned revascularization.
Conclusions:
- FFR-driven revascularization is associated with a lower rate of MI in the overall population and acute coronary syndrome subset.
- Achieved with substantially fewer revascularization procedures compared to angiography alone.
Background:
Randomized controlled trials (RCTs) comparing the clinical outcomes of fractional flow reserve (FFR)-guided and angiography-guided revascularization in patients with coronary artery disease yielded inconsistent results.
Aims:
This study aimed to assess whether FFR-guided revascularization reduces the rates of hard clinical endpoints in comparison with the angiography-guided approach alone.
Methods:
This systematic review was conducted in June 2024 using Embase, Clinicaltrials.gov, Cochrane Library, and EBSCO databases. Only RCTs that evaluated stable and unstable coronary artery disease and acute myocardial infarction (MI) were included. Eight RCTs involving 4713 patients were included in the meta-analysis.
Results:
FFR guidance was associated with a reduction in MI (risk ratio [RR], 0.75 [95% confidence interval [CI], 0.58-0.96]; P = 0.02) and a lower rate of revascularization (standardized mean difference - 0.12 [95% CI, -0.14 to 0.09]; P <00001). There were no differences between FFR-guided and angio-guided revascularization in major adverse cardiovascular events (RR, 0.84 [95% CI, 0.69-1.02]; P = 0.08), all-cause mortality (RR, 1.00 [95% CI, 0.58-1.74]; P = 0.99), and unplanned revascularization (RR, 0.89 [95% CI, 0.72-1.10]; P = 0.28).
Conclusions:
FFR-driven revascularization was associated with a significantly lower rate of MI for the entire population and also the acute coronary syndrome subset. These results were achieved with substantially fewer revascularization procedures compared with angiographic guidance alone.
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