Fractional flow reserve versus angiography–guided management of coronary artery disease: a meta-analysis of contemporary randomised controlled trials
Fractional flow reserve versus angiography–guided management of coronary artery disease: a meta-analysis of contemporary randomised controlled trials
Background and Aims: Randomised controlled trials (RCTs) comparing outcomes after fractional flow reserve (FFR)-guided versus angiography-guided management for obstructive coronary artery disease (CAD) have produced conflicting results. We investigated the efficacy and safety of an FFR-guided versus angiography-guided management strategy among patients with obstructive CAD. Methods: A systematic electronic search of the major databases was performed from inception to September 2022. We included studies of patients presenting with angina or myocardial infarction (MI), managed with medications, percutaneous coronary intervention, or bypass graft surgery. A meta-analysis was performed by pooling the risk ratio (RR) using a random-effects model. The endpoints of interest were all-cause mortality, MI and unplanned revascularisation. Results: Eight RCTs, with outcome data from 5077 patients, were included. The weighted mean follow up was 22 months. When FFR-guided management was compared to angiography-guided management, there was no difference in all-cause mortality [3.5% vs. 3.7%, RR: 0.99 (95% confidence interval (CI) 0.62–1.60), p = 0.98, heterogeneity (I
2) 43%], MI [5.3% vs. 5.9%, RR: 0.93 (95%CI 0.66–1.32), p = 0.69, I
2 42%], or unplanned revascularisation [7.4% vs. 7.9%, RR: 0.92 (95%CI 0.76–1.11), p = 0.37, I
2 0%]. However, the number patients undergoing planned revascularisation by either stent or surgery was significantly lower with an FFR-guided strategy [weighted mean difference: 14 (95% CI 3 to 25)%, p =< 0.001]. Conclusion: In patients with obstructive CAD, an FFR-guided management strategy did not impact on all-cause mortality, MI and unplanned revascularisation, when compared to an angiography-guided management strategy, but led to up to a quarter less patients needing revascularisation.
angiography, coronary artery bypass graft surgery, coronary artery disease, fractional flow reserve, percutaneous coronary intervention
Maznyczka, Annette M.
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Matthews, Connor J
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Blaxill, Jonathan M
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Greenwood, John P.
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Mozid, Abdul M.
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Rossington, Jenifer A
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Veerasamy, Murugapathy
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Wheatcroft, Stephen B.
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Curzen, Nicholas
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Bullock, Heerajnarain
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December 2022
Maznyczka, Annette M.
9cd9f743-128d-4644-ba7b-1ccb0ffa4aa9
Matthews, Connor J
30825d11-ed91-4670-a5c9-e2477ab65bed
Blaxill, Jonathan M
36d98a38-29f3-407a-bcd6-58384e558d04
Greenwood, John P.
af864161-94e9-4094-9c1f-85d696682fb7
Mozid, Abdul M.
aa5c7bf9-c5af-43ca-b070-4f5514b390be
Rossington, Jenifer A
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Veerasamy, Murugapathy
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Wheatcroft, Stephen B.
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Curzen, Nicholas
70f3ea49-51b1-418f-8e56-8210aef1abf4
Bullock, Heerajnarain
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Maznyczka, Annette M., Matthews, Connor J, Blaxill, Jonathan M, Greenwood, John P., Mozid, Abdul M., Rossington, Jenifer A, Veerasamy, Murugapathy, Wheatcroft, Stephen B., Curzen, Nicholas and Bullock, Heerajnarain
(2022)
Fractional flow reserve versus angiography–guided management of coronary artery disease: a meta-analysis of contemporary randomised controlled trials.
Journal of Cardiovascular Medicine, 11 (23), [7092].
(doi:10.3390/jcm11237092).
Abstract
Background and Aims: Randomised controlled trials (RCTs) comparing outcomes after fractional flow reserve (FFR)-guided versus angiography-guided management for obstructive coronary artery disease (CAD) have produced conflicting results. We investigated the efficacy and safety of an FFR-guided versus angiography-guided management strategy among patients with obstructive CAD. Methods: A systematic electronic search of the major databases was performed from inception to September 2022. We included studies of patients presenting with angina or myocardial infarction (MI), managed with medications, percutaneous coronary intervention, or bypass graft surgery. A meta-analysis was performed by pooling the risk ratio (RR) using a random-effects model. The endpoints of interest were all-cause mortality, MI and unplanned revascularisation. Results: Eight RCTs, with outcome data from 5077 patients, were included. The weighted mean follow up was 22 months. When FFR-guided management was compared to angiography-guided management, there was no difference in all-cause mortality [3.5% vs. 3.7%, RR: 0.99 (95% confidence interval (CI) 0.62–1.60), p = 0.98, heterogeneity (I
2) 43%], MI [5.3% vs. 5.9%, RR: 0.93 (95%CI 0.66–1.32), p = 0.69, I
2 42%], or unplanned revascularisation [7.4% vs. 7.9%, RR: 0.92 (95%CI 0.76–1.11), p = 0.37, I
2 0%]. However, the number patients undergoing planned revascularisation by either stent or surgery was significantly lower with an FFR-guided strategy [weighted mean difference: 14 (95% CI 3 to 25)%, p =< 0.001]. Conclusion: In patients with obstructive CAD, an FFR-guided management strategy did not impact on all-cause mortality, MI and unplanned revascularisation, when compared to an angiography-guided management strategy, but led to up to a quarter less patients needing revascularisation.
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jcm-2043708
- Accepted Manuscript
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jcm-11-07092
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Accepted/In Press date: 28 November 2022
Published date: December 2022
Additional Information:
Funding Information:
A. Stefi gratefully acknowledges the support of this research, which was co-financed by Greece and the European Union (European Social Fund- ESF) through the Operational Program “Human Resources Development, Education and Life-long Learning” in the context of the project “Reinforcement of Postdoctoral Re-searchers—2nd Cycle” (MIS-5033021), implemented by the State Scholarships Foundation (ΙΚΥ).
Publisher Copyright:
© 2022 by the authors.
Keywords:
angiography, coronary artery bypass graft surgery, coronary artery disease, fractional flow reserve, percutaneous coronary intervention
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Local EPrints ID: 473214
URI: http://eprints.soton.ac.uk/id/eprint/473214
ISSN: 1558-2027
PURE UUID: ada627df-8add-4715-b020-6495ccff41d8
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Date deposited: 12 Jan 2023 18:00
Last modified: 06 Jun 2024 04:06
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Author:
Annette M. Maznyczka
Author:
Connor J Matthews
Author:
Jonathan M Blaxill
Author:
John P. Greenwood
Author:
Abdul M. Mozid
Author:
Jenifer A Rossington
Author:
Murugapathy Veerasamy
Author:
Stephen B. Wheatcroft
Author:
Heerajnarain Bullock
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