Updated Meta-Analysis Comparing FFR-Guided and Angiographic-Guided Intervention in Patients with Multivessel Coronary Artery Disease

Abstract

A new method to guide Percutaneous Coronary Interventions (PCI) and Coronary Artery Bypass Graft (CABG) interventions are by FFR, which is a measurement of the hemodynamic significance of coronary stenosis. We conducted an updated meta-analysis of all randomized controlled trials from inception to 5 December 2021 to compare studies that included patients who underwent FFR-guided PCI or CABG. The statistical analysis was performed using a random effect model to Calculate Risk Ratios (RR) and Mean Difference (MD) with 95% Confidence Intervals (CI). Five RCTs were included with a total of 2,288 patients and a median weighted follow-up period of 16.6 months. In this meta-analysis with a small sample size, there was no difference between FFR-guided and angiographicguided interventions for the rates of MACE and all-cause mortality. Moreover, the analysis showed that FFR-guided was associated with insignificantly decreased rates of MI (RR 0.77, 95% CI 0.51-1.16, p=0.21, I2=18%) and the number of revascularizations (RR 0.82, 95% CI 0.64-1.06, p=0.12, I2=0%). Finally, the average number of stents used per patient significantly favored the FFR-guided group (MD -0.16, 95% CI -0.24 to -0.07, p=0.0003, I2=93%). In conclusion, although FFR-guided did not have any benefit in decreasing MACE or allcause mortality, it was associated with improved outcomes of MI, the number of revascularizations, and the average number of stents.