Abstract
Objectives: To compare outcomes of fractional flow reserve (FFR) to angiography (ANGIO) guided percutaneous coronary intervention (PCI). Background: The results of a recent randomized controlled trial reported unfavorable effects of routine measurement of FFR, thereby questioning its validity in improving clinical outcomes. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were queried from January, 2000 through December, 2016 and studies comparing FFR and ANGIO guided PCI were included. Clinical endpoints assessed during hospitalization and at follow-up (>9 months) included: myocardial infarction (MI), major adverse cardiovascular events (MACE), target lesion revascularization (TLR), and all-cause mortality. Additional endpoints included number of PCIs performed, procedure cost, procedure time, contrast volume, and fluoroscopy time. Results: A total of 51,350 patients (age 65 years, 73% male) were included from 11 studies. The use of FFR was associated with significantly lower likelihood of MI during hospitalization (OR 0.54, 95% CI: 0.39 to 0.75, P = 0.0003) and at follow-up (OR 0.53, 95% CI: 0.40 to 0.70, P = 0.00001). Similarly, FFR-PCI was associated with lower in-hospital MACE (OR 0.51, 95% CI: 0.37 to 0.70, P = 0.0001) and follow-up MACE (OR 0.63, 95% CI: 0.47 to 0.86, P = 0.004). In-hospital TLR was lower in the FFR-PCI group (OR 0.62, 95% CI: 0.40 to 0.97, P = 0.04), but not at follow-up (OR 0.83, 95% CI: 0.50 to 1.37, P = 0.46). There was no difference of in-hospital (OR 0.58, 95% CI: 0.31 to 1.09, P = 0.09) or follow-up all-cause mortality (OR 0.84, 95%CI: 0.59 to 1.20, P = 0.34). FFR-PCI was associated with significantly less PCI (OR 0.04, 95% CI: 0.01 to 0.15, P = 0.00001) with lower procedure cost (Mean Difference −4.27, 95% CI: −6.61 to −1.92, P = 0.0004). However, no difference in procedure time (Mean Difference 0.79, 95% CI: −2.41 to 3.99, P = 0.63), contrast use (Mean Difference −8.28, 95% CI: −24.25 to 7.68, P = 0.31) or fluoroscopy time (Mean Difference 0.38, 95% CI: −2.54 to 3.31, P = 0.80) was observed. Conclusions: FFR-PCI as compared to ANGIO-PCI is associated with lower in-hospital and follow-up MI and MACE rates. Although, in-hospital TLR was lower in the FFR-PCI group, this benefit was not present after 9 months. FFR-PCI group was also associated with less PCI and lower procedure costs with no effect on procedure time, contrast volume or fluoroscopy time.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 18-27 |
| Number of pages | 10 |
| Journal | Catheterization and Cardiovascular Interventions |
| Volume | 92 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 1 2018 |
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Keywords
- coronary stenosis
- fractional flow reserve
- hemodynamic assessment
- percutaneous coronary intervention
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine
Cite this
Fractional flow reserve versus angiography guided percutaneous coronary intervention : An updated systematic review. / Enezate, Tariq; Omran, Jad; Al-Dadah, Ashraf S.; Alpert, Martin; White, Christopher J.; Abu-Fadel, Mazen; Aronow, Herbert; Cohen, Mauricio G; Aguirre, Frank; Patel, Mitul; Mahmud, Ehtisham.
In: Catheterization and Cardiovascular Interventions, Vol. 92, No. 1, 01.07.2018, p. 18-27.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Fractional flow reserve versus angiography guided percutaneous coronary intervention
T2 - An updated systematic review
AU - Enezate, Tariq
AU - Omran, Jad
AU - Al-Dadah, Ashraf S.
AU - Alpert, Martin
AU - White, Christopher J.
AU - Abu-Fadel, Mazen
AU - Aronow, Herbert
AU - Cohen, Mauricio G
AU - Aguirre, Frank
AU - Patel, Mitul
AU - Mahmud, Ehtisham
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Objectives: To compare outcomes of fractional flow reserve (FFR) to angiography (ANGIO) guided percutaneous coronary intervention (PCI). Background: The results of a recent randomized controlled trial reported unfavorable effects of routine measurement of FFR, thereby questioning its validity in improving clinical outcomes. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were queried from January, 2000 through December, 2016 and studies comparing FFR and ANGIO guided PCI were included. Clinical endpoints assessed during hospitalization and at follow-up (>9 months) included: myocardial infarction (MI), major adverse cardiovascular events (MACE), target lesion revascularization (TLR), and all-cause mortality. Additional endpoints included number of PCIs performed, procedure cost, procedure time, contrast volume, and fluoroscopy time. Results: A total of 51,350 patients (age 65 years, 73% male) were included from 11 studies. The use of FFR was associated with significantly lower likelihood of MI during hospitalization (OR 0.54, 95% CI: 0.39 to 0.75, P = 0.0003) and at follow-up (OR 0.53, 95% CI: 0.40 to 0.70, P = 0.00001). Similarly, FFR-PCI was associated with lower in-hospital MACE (OR 0.51, 95% CI: 0.37 to 0.70, P = 0.0001) and follow-up MACE (OR 0.63, 95% CI: 0.47 to 0.86, P = 0.004). In-hospital TLR was lower in the FFR-PCI group (OR 0.62, 95% CI: 0.40 to 0.97, P = 0.04), but not at follow-up (OR 0.83, 95% CI: 0.50 to 1.37, P = 0.46). There was no difference of in-hospital (OR 0.58, 95% CI: 0.31 to 1.09, P = 0.09) or follow-up all-cause mortality (OR 0.84, 95%CI: 0.59 to 1.20, P = 0.34). FFR-PCI was associated with significantly less PCI (OR 0.04, 95% CI: 0.01 to 0.15, P = 0.00001) with lower procedure cost (Mean Difference −4.27, 95% CI: −6.61 to −1.92, P = 0.0004). However, no difference in procedure time (Mean Difference 0.79, 95% CI: −2.41 to 3.99, P = 0.63), contrast use (Mean Difference −8.28, 95% CI: −24.25 to 7.68, P = 0.31) or fluoroscopy time (Mean Difference 0.38, 95% CI: −2.54 to 3.31, P = 0.80) was observed. Conclusions: FFR-PCI as compared to ANGIO-PCI is associated with lower in-hospital and follow-up MI and MACE rates. Although, in-hospital TLR was lower in the FFR-PCI group, this benefit was not present after 9 months. FFR-PCI group was also associated with less PCI and lower procedure costs with no effect on procedure time, contrast volume or fluoroscopy time.
AB - Objectives: To compare outcomes of fractional flow reserve (FFR) to angiography (ANGIO) guided percutaneous coronary intervention (PCI). Background: The results of a recent randomized controlled trial reported unfavorable effects of routine measurement of FFR, thereby questioning its validity in improving clinical outcomes. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were queried from January, 2000 through December, 2016 and studies comparing FFR and ANGIO guided PCI were included. Clinical endpoints assessed during hospitalization and at follow-up (>9 months) included: myocardial infarction (MI), major adverse cardiovascular events (MACE), target lesion revascularization (TLR), and all-cause mortality. Additional endpoints included number of PCIs performed, procedure cost, procedure time, contrast volume, and fluoroscopy time. Results: A total of 51,350 patients (age 65 years, 73% male) were included from 11 studies. The use of FFR was associated with significantly lower likelihood of MI during hospitalization (OR 0.54, 95% CI: 0.39 to 0.75, P = 0.0003) and at follow-up (OR 0.53, 95% CI: 0.40 to 0.70, P = 0.00001). Similarly, FFR-PCI was associated with lower in-hospital MACE (OR 0.51, 95% CI: 0.37 to 0.70, P = 0.0001) and follow-up MACE (OR 0.63, 95% CI: 0.47 to 0.86, P = 0.004). In-hospital TLR was lower in the FFR-PCI group (OR 0.62, 95% CI: 0.40 to 0.97, P = 0.04), but not at follow-up (OR 0.83, 95% CI: 0.50 to 1.37, P = 0.46). There was no difference of in-hospital (OR 0.58, 95% CI: 0.31 to 1.09, P = 0.09) or follow-up all-cause mortality (OR 0.84, 95%CI: 0.59 to 1.20, P = 0.34). FFR-PCI was associated with significantly less PCI (OR 0.04, 95% CI: 0.01 to 0.15, P = 0.00001) with lower procedure cost (Mean Difference −4.27, 95% CI: −6.61 to −1.92, P = 0.0004). However, no difference in procedure time (Mean Difference 0.79, 95% CI: −2.41 to 3.99, P = 0.63), contrast use (Mean Difference −8.28, 95% CI: −24.25 to 7.68, P = 0.31) or fluoroscopy time (Mean Difference 0.38, 95% CI: −2.54 to 3.31, P = 0.80) was observed. Conclusions: FFR-PCI as compared to ANGIO-PCI is associated with lower in-hospital and follow-up MI and MACE rates. Although, in-hospital TLR was lower in the FFR-PCI group, this benefit was not present after 9 months. FFR-PCI group was also associated with less PCI and lower procedure costs with no effect on procedure time, contrast volume or fluoroscopy time.
KW - coronary stenosis
KW - fractional flow reserve
KW - hemodynamic assessment
KW - percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=85051006307&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85051006307&partnerID=8YFLogxK
U2 - 10.1002/ccd.27302
DO - 10.1002/ccd.27302
M3 - Article
C2 - 28980386
AN - SCOPUS:85051006307
VL - 92
SP - 18
EP - 27
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
SN - 1522-1946
IS - 1
ER -