Impact of assessment of fractional flow reserve and instantaneous wave-free ratio on clinical outcomes of percutaneous coronary intervention: a systematic review, meta-analysis and meta-regression analysis
Aim. To conduct a systematic review and meta-analysis to compare clinical outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) using conventional coronary angiography (CAG) or fractional flow reserve (FFR)-guided PCI. In addition, FFR-guided PCI...
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«FIRMA «SILICEA» LLC
2023-03-01
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| Series: | Российский кардиологический журнал |
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| Online Access: | https://russjcardiol.elpub.ru/jour/article/view/5325 |
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| author | E. Z. Golukhova K. V. Petrosian A. V. Abrosimov N. I. Bulaeva E. S. Goncharova B. Sh. Berdibekov |
| author_facet | E. Z. Golukhova K. V. Petrosian A. V. Abrosimov N. I. Bulaeva E. S. Goncharova B. Sh. Berdibekov |
| author_sort | E. Z. Golukhova |
| collection | DOAJ |
| description | Aim. To conduct a systematic review and meta-analysis to compare clinical outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) using conventional coronary angiography (CAG) or fractional flow reserve (FFR)-guided PCI. In addition, FFR-guided PCI and PCI guided with instantaneous wave-free ratio (iFR) were compared.Material and methods. PubMed, Google Scholar databases were searched for studies comparing clinical outcomes in patients with CAD undergoing CAG-guided or FFR/iFR-guided PCI. Dichotomous data analysis was presented as odds ratio (OR) with 95% confidence interval (CI). Adjusted hazard ratio (HR) values from studies with similar evaluation criteria were pooled for meta-analysis.Results. Six randomized controlled trials (RCTs) from 184 publications were selected for this systematic review and meta-analysis. A total of 2193 patients (mean age, 64,2 years, mean follow-up, 28,0 months) were included. Analysis of RCTs showed that CAG-guided and FFR-guided PCI did not have a significant difference in the incidence of major adverse cardiovascular events (MACE) (OR: 0,78; 95% CI: 0,61-1,00; p=0,05; I2=0%), all-cause death (OR: 0,86; 95% CI: 0,51-1,44; p=0,57; I2=0%) or emergency revascularization (OR: 0,69, 95% CI: 0,46-1,04, p=0,08, I2=0%). However, FFR-guided PCI was associated with a reduced risk of subsequent MI compared with CAG-guided PCI (OR: 0,70; 95% CI: 0,50-0,99; p=0,04; I2=0%). In addition to the results of previous RCTs, we conducted a metaanalysis of 3 observational studies. In total, the CAG-guided and FFR-guided PCI groups included 165012 and 11450 patients, respectively. A meta-analysis showed that FFR-guided PCI was associated with a reduced risk of all-cause mortality (HR: 0,74; 95% CI: 0,63-0,87; P=0,0003) and MI (HR: 0,75; 95% CI: 0,61-0,94; p=0,01). In addition, there was no significant difference between iFRand FFR-guided PCI in terms of MACE (OR: 0,97; 95% CI: 0,76-1,23; p=0,81), all-cause mortality (OR: 0,66; 95% CI: 0,40-1,10; p=0,11), MI (OR: 0,83; 95% CI: 0,56-1,24; p=0,37) or emergency repeated revascularization (OR: 1,16; 95% CI: 0,85-1,58; p=0,34).Conclusion. FFR-guided PCI is associated with a reduced risk of all-cause mortality and subsequent MI compared with CAG-guided PCI. At the same time, the iFR-guided PCI is not inferior to the FFR-guided method in terms of MACE rate. |
| format | Article |
| id | doaj-art-14d1d0d1a58e4b99a958c37027e4ce0f |
| institution | Kabale University |
| issn | 1560-4071 2618-7620 |
| language | Russian |
| publishDate | 2023-03-01 |
| publisher | «FIRMA «SILICEA» LLC |
| record_format | Article |
| series | Российский кардиологический журнал |
| spelling | doaj-art-14d1d0d1a58e4b99a958c37027e4ce0f2025-08-20T03:57:22Zrus«FIRMA «SILICEA» LLCРоссийский кардиологический журнал1560-40712618-76202023-03-01281S10.15829/1560-4071-2023-53253759Impact of assessment of fractional flow reserve and instantaneous wave-free ratio on clinical outcomes of percutaneous coronary intervention: a systematic review, meta-analysis and meta-regression analysisE. Z. Golukhova0K. V. Petrosian1A. V. Abrosimov2N. I. Bulaeva3E. S. Goncharova4B. Sh. Berdibekov5A. N. Bakulev National Medical Research Center for Cardiovascular SurgeryA. N. Bakulev National Medical Research Center for Cardiovascular SurgeryA. N. Bakulev National Medical Research Center for Cardiovascular SurgeryA. N. Bakulev National Medical Research Center for Cardiovascular SurgeryA. N. Bakulev National Medical Research Center for Cardiovascular SurgeryA. N. Bakulev National Medical Research Center for Cardiovascular SurgeryAim. To conduct a systematic review and meta-analysis to compare clinical outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) using conventional coronary angiography (CAG) or fractional flow reserve (FFR)-guided PCI. In addition, FFR-guided PCI and PCI guided with instantaneous wave-free ratio (iFR) were compared.Material and methods. PubMed, Google Scholar databases were searched for studies comparing clinical outcomes in patients with CAD undergoing CAG-guided or FFR/iFR-guided PCI. Dichotomous data analysis was presented as odds ratio (OR) with 95% confidence interval (CI). Adjusted hazard ratio (HR) values from studies with similar evaluation criteria were pooled for meta-analysis.Results. Six randomized controlled trials (RCTs) from 184 publications were selected for this systematic review and meta-analysis. A total of 2193 patients (mean age, 64,2 years, mean follow-up, 28,0 months) were included. Analysis of RCTs showed that CAG-guided and FFR-guided PCI did not have a significant difference in the incidence of major adverse cardiovascular events (MACE) (OR: 0,78; 95% CI: 0,61-1,00; p=0,05; I2=0%), all-cause death (OR: 0,86; 95% CI: 0,51-1,44; p=0,57; I2=0%) or emergency revascularization (OR: 0,69, 95% CI: 0,46-1,04, p=0,08, I2=0%). However, FFR-guided PCI was associated with a reduced risk of subsequent MI compared with CAG-guided PCI (OR: 0,70; 95% CI: 0,50-0,99; p=0,04; I2=0%). In addition to the results of previous RCTs, we conducted a metaanalysis of 3 observational studies. In total, the CAG-guided and FFR-guided PCI groups included 165012 and 11450 patients, respectively. A meta-analysis showed that FFR-guided PCI was associated with a reduced risk of all-cause mortality (HR: 0,74; 95% CI: 0,63-0,87; P=0,0003) and MI (HR: 0,75; 95% CI: 0,61-0,94; p=0,01). In addition, there was no significant difference between iFRand FFR-guided PCI in terms of MACE (OR: 0,97; 95% CI: 0,76-1,23; p=0,81), all-cause mortality (OR: 0,66; 95% CI: 0,40-1,10; p=0,11), MI (OR: 0,83; 95% CI: 0,56-1,24; p=0,37) or emergency repeated revascularization (OR: 1,16; 95% CI: 0,85-1,58; p=0,34).Conclusion. FFR-guided PCI is associated with a reduced risk of all-cause mortality and subsequent MI compared with CAG-guided PCI. At the same time, the iFR-guided PCI is not inferior to the FFR-guided method in terms of MACE rate.https://russjcardiol.elpub.ru/jour/article/view/5325percutaneous coronary interventioncoronary angiographyfractional flow reserveinstantaneous wave-free ratio |
| spellingShingle | E. Z. Golukhova K. V. Petrosian A. V. Abrosimov N. I. Bulaeva E. S. Goncharova B. Sh. Berdibekov Impact of assessment of fractional flow reserve and instantaneous wave-free ratio on clinical outcomes of percutaneous coronary intervention: a systematic review, meta-analysis and meta-regression analysis Российский кардиологический журнал percutaneous coronary intervention coronary angiography fractional flow reserve instantaneous wave-free ratio |
| title | Impact of assessment of fractional flow reserve and instantaneous wave-free ratio on clinical outcomes of percutaneous coronary intervention: a systematic review, meta-analysis and meta-regression analysis |
| title_full | Impact of assessment of fractional flow reserve and instantaneous wave-free ratio on clinical outcomes of percutaneous coronary intervention: a systematic review, meta-analysis and meta-regression analysis |
| title_fullStr | Impact of assessment of fractional flow reserve and instantaneous wave-free ratio on clinical outcomes of percutaneous coronary intervention: a systematic review, meta-analysis and meta-regression analysis |
| title_full_unstemmed | Impact of assessment of fractional flow reserve and instantaneous wave-free ratio on clinical outcomes of percutaneous coronary intervention: a systematic review, meta-analysis and meta-regression analysis |
| title_short | Impact of assessment of fractional flow reserve and instantaneous wave-free ratio on clinical outcomes of percutaneous coronary intervention: a systematic review, meta-analysis and meta-regression analysis |
| title_sort | impact of assessment of fractional flow reserve and instantaneous wave free ratio on clinical outcomes of percutaneous coronary intervention a systematic review meta analysis and meta regression analysis |
| topic | percutaneous coronary intervention coronary angiography fractional flow reserve instantaneous wave-free ratio |
| url | https://russjcardiol.elpub.ru/jour/article/view/5325 |
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