Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2015 Mar;101(6):455-62.
doi: 10.1136/heartjnl-2014-306578. Epub 2015 Jan 30.

Fractional flow reserve versus angiography for guiding percutaneous coronary intervention: a meta-analysis

Dongfeng Zhang  1 , Shuzheng Lv  1 , Xiantao Song  1 , Fei Yuan  1 , Feng Xu  1 , Min Zhang  1 , Shuai Yan  1 , Xingmei Cao  1
Affiliations
Meta-Analysis

Fractional flow reserve versus angiography for guiding percutaneous coronary intervention: a meta-analysis

Dongfeng Zhang et al. Heart. 2015 Mar.

Abstract

Objectives: The purpose of this study was to investigate whether fractional flow reserve (FFR) should be performed for patients with coronary artery disease (CAD) to guide the percutaneous coronary intervention (PCI) strategy.

Background: PCI is the most effective method to improve the outcomes of CAD. However, the proper usage of PCI has not been achieved in clinical practice.

Methods: A meta-analysis was performed on angiography-guided PCI and FFR-guided PCI strategies. Prospective and retrospective studies were included when research subjects were patients with CAD undergoing PCI. The primary endpoint was the rate of major adverse cardiac events (MACE) or major adverse cardiac and cerebrovascular events (MACCE). Secondary endpoints included death, myocardial infarction (MI), repeat revascularisation and death or MI.

Results: Four prospective and three retrospective studies involving 49 517 patients were included. Absolute risks of MACE/MACCE, death, MI, revascularisation and death or MI for angiography-guided PCI and FFR-guided PCI were 34.8% vs 22.5%, 15.3% vs 7.6%, 8.1% vs 4.2%, 20.4% vs 14.8%, and 21.9% vs 11.8%, respectively. The meta-analysis demonstrated that FFR-guided PCI was associated with lower MACE/MACCE (OR: 1.71, 95% CI 1.31 to 2.23), death (OR: 1.64, 95% CI 1.37 to 1.96), MI (OR: 2.05, 95% CI 1.61 to 2.60), repeat revascularisation (OR: 1.25, 95% CI 1.09 to 1.44), and death or MI (OR: 1.84, 95% CI 1.58 to 2.15) than angiography-guided PCI strategy.

Conclusions: This meta-analysis supports current guidelines advising the FFR-guided PCI strategy for CAD. PCI should only be performed when haemodynamic significance is found.

Keywords: CORONARY ARTERY DISEASE; INTERVENTIONAL CARDIOLOGY.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of study inclusion and exclusion criteria.
Figure 2
Figure 2
Angiography-guided percutaneous coronary intervention (PCI) versus fractional flow reserve-guided PCI major adverse cardiac events/major adverse cardiac and cerebrovascular events.
Figure 3
Figure 3
Angiography-guided percutaneous coronary intervention (PCI) versus fractional flow reserve-guided PCI death.
Figure 4
Figure 4
Angiography-guided percutaneous coronary intervention (PCI) versus fractional flow reserve-guided PCI myocardial infarction.
Figure 5
Figure 5
Angiography-guided percutaneous coronary intervention (PCI) versus fractional flow reserve-guided PCI repeat revascularisation.
Figure 6
Figure 6
Angiography-guided percutaneous coronary intervention (PCI) versus fractional flow reserve-guided PCI death or myocardial infarction.
See this image and copyright information in PMC

References

    1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3:e442 10.1371/journal.pmed.0030442 - DOI - PMC - PubMed
    1. Shaw LJ, Iskandrian AE. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol 2004;11:171–85. 10.1016/j.nuclcard.2003.12.004 - DOI - PubMed
    1. Pijls NH, van Son JA, Kirkeeide RL, et al. . Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty. Circulation 1993;87:1354–67. 10.1161/01.CIR.87.4.1354 - DOI - PubMed
    1. Pijls NH, Van Gelder B, Van der Voort P, et al. . Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation 1995;92:3183–93. 10.1161/01.CIR.92.11.3183 - DOI - PubMed
    1. Pijls NH, Fearon WF, Tonino PA, et al. . Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J Am Coll Cardiol 2010;56:177–84. 10.1016/j.jacc.2010.04.012 - DOI - PubMed

Publication types

MeSH terms