Comparative Outcomes of Fractional Flow Reserve and Intravascular Ultrasound Guidance for Percutaneous Coronary
Eyad Jamileh1, Zuha Akhtar2, Kanita Farooq3
1Royal Blackburn Teaching Hospital, East Lancashire Hospitals Trust, Blackburn, England, UK.
Objective:
Advanced techniques beyond angiography increasingly guide percutaneous coronary intervention (PCI). Fractional flow reserve (FFR) and intravascular ultrasound (IVUS) are widely used for physiological and anatomical guidance, respectively. This study compares clinical outcomes of FFR versus IVUS-guided PCI.
Methods:
We conducted a systematic review and meta-analysis that identified studies comparing FFR- and IVUS-guided PCI. Primary outcomes included major adverse cardiovascular events (MACE), all-cause mortality, cardiac death, nonfatal myocardial infarction (MI) and target vessel revascularisation (TVR). A secondary outcome was the number of PCI procedures performed. Random effects modelling was used for all outcomes.
Results:
Six studies comprising 5040 patients (FFR: 2517; IVUS: 2523) were included. There were no significant differences between FFR- and IVUS-guided PCI in the incidence of MACE (RR = 1.13, 95% CI 0.89-1.44), all-cause mortality (RR = 0.82, 95% CI 0.41-1.64), cardiac death (RR = 1.05, 95% CI 0.60-1.85), nonfatal MI (RR = 1.35, 95% CI 0.72-2.52) or TVR (RR = 1.21, 95% CI 0.81-1.81). Subgroup analyses by study design (observational studies and randomised control trials) showed no significant effect modification for any outcome. There was no significant difference in the number of PCI procedures performed (RR = 0.78, 95% CI 0.59-1.02), although heterogeneity was high (I2 = 95%).
Conclusion:
FFR and IVUS are both effective for guiding PCI, with similar outcomes in terms of MACE, mortality, MI, TVR and PCI procedures performed. Modality selection should be tailored to lesion complexity, institutional expertise and resource availability.
