Background:
When non-invasive studies for ischemia are not conclusive or are unavailable, assessment of fractional flow reserve ( FFR) is the standard of care for intermediate-severity coronary lesions before undertaking revascularization. However, recent randomized clinical trials (RCTs) have suggested that FFR-guided revascularization might not be superior to angiographically
-guided revascularization ( e.g., the FARGO trial) and might even be potentially harmful (e.g., the FUTURE trial). Therefore, we performed an updated comprehensive meta-analysis of clinical trials to compare the efficacy and safety of FFR-guided coronary revascularization versus angiographically-guided revascularization.
Methods:
Scientific databases were searched for RCTs, and pooled risk ratios (RRs) were determined using both a random effects model and a fixed effects model.
Results:
Data from 2029 patients were analyzed. The risks for MACEs (RR, 0.85; 95% CI, 0.66–1.10;
p = 0.23), MI (RR, 0.82; 95% CI, 0.56–1.18;
p = 0.82), and all-cause death (RR, 0.99; 95% CI, 0.29–3.34;
p = 0.99) for FFR-guided revascularization were similar to those for angiographically-guided revascularization. The risk for recurrent revascularization was numerically lower with FFR-guided revascularization but did not reach statistical significance (RR, 0.76; 95% CI, 0.57–1.01;
p = 0.060). Results from the fixed effects model were consistent with those from the random effects model.
Conclusions:
This updated meta-analysis of RCTs seems to suggest that FFR-guided revascularization is not superior to angiographically-guided revascularization. However, the majority of included trials were small; therefore, ongoing larger trials (i.e., the GRAFFITI and FAME-3 trials) will provide additional insight on this subject.
