Fractional flow reserve guided percutaneous coronary intervention vs coronary artery bypass grafting for multivessel coronary artery disease: A meta-analysis.

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

World Journal of Cardiology Pub Date : 2025-09-26 DOI:10.4330/wjc.v17.i9.111044

Suhas Kataveni, Ezza Ellahi, Fabeha Zafar, Ihsan Noushad Karuppan Veettil, Amna Iqbal, Bhavya Dhir, Shivani Sabarish, Sai Erambalur, Meenakshi Reddy Yathindra, Moukthika Kvn, Shayan Nawaz, Satish Kumar Dudekula, Usman Ul Haq, Asraf Hussain, Muhammad Muneeb Khawar

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Abstract

Background: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are well-established treatments for multivessel coronary artery disease (CAD), a condition where multiple heart arteries are narrowed. A newer approach, fractional flow reserve (FFR)-guided PCI, uses a specialized measurement to select which artery blockages to treat, aiming to enhance patient outcomes. Despite its adoption, the comparative effectiveness of FFR-guided PCI vs CABG remains unclear, particularly regarding key health outcomes such as survival, heart-related complications, and the need for further procedures.

Aim: To evaluate the safety and effectiveness of FFR -guided PCI compared to CABG in patients with multivessel CAD.

Methods: This meta-analysis followed standard reporting guidelines and included randomized controlled trials (RCTs) comparing FFR-guided PCI with CABG in patients with multivessel CAD. We searched medical databases, including PubMed, EMBASE, ScienceDirect, and ClinicalTrials.gov, from their start to May 2025. We calculated combined risk ratios (RRs) with 95% confidence intervals (95%CIs) to analyze the data.

Results: Three RCTs were analyzed. There was no notable difference in all-cause mortality between FFR-guided PCI and CABG (RR = 1.01, 95%CI: 0.78-1.31, P = 0.93). However, FFR-guided PCI showed higher rates of major adverse cardiac events (MACEs; RR = 1.30, 95%CI: 1.11-1.52, P = 0.001), myocardial infarction (RR = 1.49, 95%CI: 1.11-2.01, P = 0.009), and repeat revascularization (RR = 2.25, 95%CI: 1.78-2.85, P < 0.00001). Stroke rates were comparable between the two treatments (RR = 0.80, 95%CI: 0.54-1.20, P = 0.28).

Conclusion: FFR-guided PCI and CABG have similar rates of all-cause mortality and stroke in patients with multivessel CAD. However, CABG results in fewer MACEs, myocardial infarctions, and repeat procedures.

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分流储备引导下经皮冠状动脉介入治疗vs冠状动脉旁路移植术治疗多支冠状动脉疾病：meta分析

背景：冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）是治疗多支冠状动脉疾病（CAD）的有效方法。一种较新的方法，分数血流储备（FFR）引导的PCI，使用一种专门的测量方法来选择治疗哪种动脉阻塞，旨在提高患者的预后。尽管采用了ffr，但ffr引导下的PCI与CABG的比较效果仍不清楚，特别是在生存、心脏相关并发症和进一步手术的需要等关键健康结果方面。目的：评价FFR引导下PCI与CABG在多血管CAD患者中的安全性和有效性。方法：本荟萃分析遵循标准报告指南，纳入随机对照试验（rct），比较ffr引导下的PCI与CABG在多血管CAD患者中的应用。我们检索了医学数据库，包括PubMed， EMBASE， ScienceDirect和ClinicalTrials.gov，从它们开始到2025年5月。我们以95%置信区间（95% ci）计算合并风险比（rr）来分析数据。结果：对3项随机对照试验进行分析。ffr引导下PCI与CABG的全因死亡率无显著性差异（RR = 1.01, 95%CI: 0.78 ~ 1.31, P = 0.93）。然而，ffr引导下PCI的主要不良心脏事件（mace; RR = 1.30, 95%CI: 1.11 ~ 1.52, P = 0.001）、心肌梗死（RR = 1.49, 95%CI: 1.11 ~ 2.01, P = 0.009）和重复血运重成率（RR = 2.25, 95%CI: 1.78 ~ 2.85, P < 0.00001）较高。两组间卒中发生率比较（RR = 0.80, 95%CI: 0.54 ~ 1.20, P = 0.28）。结论：ffr引导下的PCI和CABG在多血管CAD患者的全因死亡率和卒中发生率相似。然而，冠脉搭桥导致较少的mace、心肌梗死和重复手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

3.30

自引率

5.30%

发文量