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Impact of impaired fractional flow reserve after coronary interventions on outcomes: a systematic review and meta-analysis

Impact of impaired fractional flow reserve after coronary interventions on outcomes: a systematic review and meta-analysis
Impact of impaired fractional flow reserve after coronary interventions on outcomes: a systematic review and meta-analysis

BACKGROUND: FFR is routinely used to guide percutaneous coronary interventions (PCI). Visual assessment of the angiographic result after PCI has limited efficacy. Even when the angiographic result seems satisfactory FFR after a PCI might be useful for identifying patients with a suboptimal interventional result and higher risk for poor clinical outcome who might benefit from additional procedures. The aim of this meta-analysis was to investigate available data of studies that examined clinical outcomes of patients with impaired vs. satisfactory fractional flow reserve (FFR) after percutaneous coronary interventions (PCI).

METHODS: This meta-analysis was carried out according to the Cochrane Handbook for Systematic Reviews. The Mantel-Haenszel method using the fixed-effect meta-analysis model was used for combining the results. Studies were identified by searching the literature through mid-January, 2016, using the following search terms: fractional flow reserve, coronary circulation, after, percutaneous coronary intervention, balloon angioplasty, stent implantation, and stenting. Primary endpoint was the rate of major adverse cardiac events (MACE). Secondary endpoints included rates of death, myocardial infarction (MI), repeated revascularisation.

RESULTS: Eight relevant studies were found including a total of 1337 patients. Of those, 492 (36.8 %) had an impaired FFR after PCI, and 853 (63.2 %) had a satisfactory FFR after PCI. Odds ratios indicated that a low FFR following PCI was associated with an impaired outcome: major adverse cardiac events (MACE, OR: 4.95, 95 % confidence interval [CI]: 3.39-7.22, p <0.001); death (OR: 3.23, 95 % CI: 1.19-8.76, p = 0.022); myocardial infarction (OR: 13.83, 95 % CI: 4.75-40.24, p <0.0001) and repeated revascularisation (OR: 4.42, 95 % CI: 2.73-7.15, p <0.0001).

CONCLUSIONS: Compared to a satisfactory FFR, a persistently low FFR following PCI is associated with a worse clinical outcome. Prospective studies are needed to identify underlying causes, determine an optimal threshold for post-PCI FFR, and clarify whether simple additional procedures can influence the post-PCI FFR and clinical outcome.

Coronary Angiography, Coronary Artery Disease/diagnostic imaging, Fractional Flow Reserve, Myocardial, Humans, Myocardial Infarction/etiology, Odds Ratio, Percutaneous Coronary Intervention/adverse effects, Predictive Value of Tests, Retreatment, Risk Assessment, Risk Factors, Treatment Outcome
1471-2261
1-9
Wolfrum, Mathias
e362d287-45bb-463b-9d18-ca0001913db9
Fahrni, Gregor
48294a0b-5dec-4710-8e5e-1cb5e01af433
de Maria, Giovanni Luigi
1037ca1a-5e1f-4498-bc8f-769c31aaff27
Knapp, Guido
2018478d-18b3-4e34-8bf1-d1e233cbbb60
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Kharbanda, Rajesh K
5feec5eb-ed56-431e-89ac-2777512bf005
Fröhlich, Georg M
42a44508-ae2e-4199-8bca-80e030adebbe
Banning, Adrian P
63c9376f-08b6-4578-b036-4d6233545270
Wolfrum, Mathias
e362d287-45bb-463b-9d18-ca0001913db9
Fahrni, Gregor
48294a0b-5dec-4710-8e5e-1cb5e01af433
de Maria, Giovanni Luigi
1037ca1a-5e1f-4498-bc8f-769c31aaff27
Knapp, Guido
2018478d-18b3-4e34-8bf1-d1e233cbbb60
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Kharbanda, Rajesh K
5feec5eb-ed56-431e-89ac-2777512bf005
Fröhlich, Georg M
42a44508-ae2e-4199-8bca-80e030adebbe
Banning, Adrian P
63c9376f-08b6-4578-b036-4d6233545270

Wolfrum, Mathias, Fahrni, Gregor, de Maria, Giovanni Luigi, Knapp, Guido, Curzen, Nick, Kharbanda, Rajesh K, Fröhlich, Georg M and Banning, Adrian P (2016) Impact of impaired fractional flow reserve after coronary interventions on outcomes: a systematic review and meta-analysis. BMC Cardiovascular Disorders, 16 (1), 1-9, [177]. (doi:10.1186/s12872-016-0355-7).

Record type: Review

Abstract

BACKGROUND: FFR is routinely used to guide percutaneous coronary interventions (PCI). Visual assessment of the angiographic result after PCI has limited efficacy. Even when the angiographic result seems satisfactory FFR after a PCI might be useful for identifying patients with a suboptimal interventional result and higher risk for poor clinical outcome who might benefit from additional procedures. The aim of this meta-analysis was to investigate available data of studies that examined clinical outcomes of patients with impaired vs. satisfactory fractional flow reserve (FFR) after percutaneous coronary interventions (PCI).

METHODS: This meta-analysis was carried out according to the Cochrane Handbook for Systematic Reviews. The Mantel-Haenszel method using the fixed-effect meta-analysis model was used for combining the results. Studies were identified by searching the literature through mid-January, 2016, using the following search terms: fractional flow reserve, coronary circulation, after, percutaneous coronary intervention, balloon angioplasty, stent implantation, and stenting. Primary endpoint was the rate of major adverse cardiac events (MACE). Secondary endpoints included rates of death, myocardial infarction (MI), repeated revascularisation.

RESULTS: Eight relevant studies were found including a total of 1337 patients. Of those, 492 (36.8 %) had an impaired FFR after PCI, and 853 (63.2 %) had a satisfactory FFR after PCI. Odds ratios indicated that a low FFR following PCI was associated with an impaired outcome: major adverse cardiac events (MACE, OR: 4.95, 95 % confidence interval [CI]: 3.39-7.22, p <0.001); death (OR: 3.23, 95 % CI: 1.19-8.76, p = 0.022); myocardial infarction (OR: 13.83, 95 % CI: 4.75-40.24, p <0.0001) and repeated revascularisation (OR: 4.42, 95 % CI: 2.73-7.15, p <0.0001).

CONCLUSIONS: Compared to a satisfactory FFR, a persistently low FFR following PCI is associated with a worse clinical outcome. Prospective studies are needed to identify underlying causes, determine an optimal threshold for post-PCI FFR, and clarify whether simple additional procedures can influence the post-PCI FFR and clinical outcome.

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More information

Published date: 8 September 2016
Keywords: Coronary Angiography, Coronary Artery Disease/diagnostic imaging, Fractional Flow Reserve, Myocardial, Humans, Myocardial Infarction/etiology, Odds Ratio, Percutaneous Coronary Intervention/adverse effects, Predictive Value of Tests, Retreatment, Risk Assessment, Risk Factors, Treatment Outcome

Identifiers

Local EPrints ID: 436090
URI: http://eprints.soton.ac.uk/id/eprint/436090
ISSN: 1471-2261
PURE UUID: 447fbd34-d9dd-4502-9fa2-58ecc1619cee
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 27 Nov 2019 17:30
Last modified: 10 Jan 2022 02:50

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Contributors

Author: Mathias Wolfrum
Author: Gregor Fahrni
Author: Giovanni Luigi de Maria
Author: Guido Knapp
Author: Nick Curzen ORCID iD
Author: Rajesh K Kharbanda
Author: Georg M Fröhlich
Author: Adrian P Banning

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