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Updated: Jun 23, 2026
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Fractional Flow Reserve-Guided Versus Coronary Angiography Alone for Guiding Coronary Artery Bypass Grafting: A
Omar Fayez Abbas1, Ahmed Emara1, Abdullah Almarfadi2
1Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Insights
Fractional flow reserve (FFR)-guided coronary artery bypass grafting (CABG) significantly reduces myocardial infarction (MI) risk compared to traditional angiography guidance. This meta-analysis suggests FFR may improve surgical revascularization outcomes, though further research is needed.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Trials Methodology
Background:
- Coronary artery bypass grafting (CABG) traditionally relies on coronary angiography, which may overestimate or underestimate lesion severity.
- Fractional flow reserve (FFR) is established for guiding percutaneous coronary intervention but its role in CABG is less clear.
Purpose of the Study:
- To conduct a meta-analysis of randomized controlled trials (RCTs) comparing FFR-guided versus angiography-guided CABG.
- To assess the impact of FFR guidance on major adverse cardiac and cerebrovascular events.
Main Methods:
- Systematic search of electronic databases for RCTs comparing FFR-guided vs. angiography-guided CABG.
- Inclusion of 3 RCTs with 1,061 patients; meta-analysis using random-effects models.
- Primary outcomes: all-cause death, myocardial infarction (MI), and stroke; mean follow-up of 15 months.
Main Results:
- FFR-guided CABG was associated with a significantly lower risk of MI (RR 0.48, 95% CI 0.26-0.89).
- No significant differences were observed in all-cause death (RR 0.74, 95% CI 0.52-1.07) or stroke (RR 1.60, 95% CI 0.94-2.74).
- Low risk of bias across included trials.
Conclusions:
- FFR-guided CABG demonstrates a reduced incidence of MI compared to angiography-guided CABG.
- Current evidence suggests FFR guidance may enhance surgical revascularization safety.
- Larger trials with longer follow-up are warranted to solidify the role of physiology-guided CABG.
Abstract:
Coronary artery bypass grafting (CABG) has been traditionally guided by coronary angiography, although angiographic severity may not accurately reflect the physiological significance of coronary lesions. Fractional flow reserve (FFR) improves outcomes in percutaneous coronary intervention, but its role in guiding CABG remains uncertain. We conducted a meta-analysis of randomized controlled trials (RCTs) comparing FFR-guided versus angiography-guided CABG. Electronic databases were systematically searched from inception to April 2026. Outcomes included all-cause death, myocardial infarction (MI), and stroke. Random-effects models were used to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs). Three RCTs including 1,061 patients were analyzed, with 533 patients assigned to FFR-guided CABG. During a mean follow-up of 15 months, FFR-guided CABG was associated with a significantly lower risk of MI compared with angiography-guided CABG (RR 0.48, 95% CI 0.26 to 0.89; p = 0.01). There were no statistically significant differences in all-cause death (RR 0.74, 95% CI 0.52 to 1.07; p = 0.10) or stroke (RR 1.60, 95% CI 0.94 to 2.74; p = 0.08). Risk of bias was low across all included trials. In conclusion, FFR-guided CABG was associated with a reduced incidence of MI compared with angiography-guided CABG, without significant differences in all-cause death or stroke. Larger trials with longer follow-up are needed to further define the role of physiology-guided surgical revascularization.
