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. 2019 Jan 13;6(1):e000934.
doi: 10.1136/openhrt-2018-000934. eCollection 2019.

Fractional flow reserve in acute coronary syndrome: a meta-analysis and systematic review

Kevin P Liou  1   2   3 , Sze-Yuan M Ooi  2   3 , Stephen P Hoole  1 , Nick E J West  1
Affiliations

Fractional flow reserve in acute coronary syndrome: a meta-analysis and systematic review

Kevin P Liou et al. Open Heart. .

Abstract

Background: The utility of fractional flow reserve (FFR) to guide revascularisation in the management of acute coronary syndrome (ACS) remains unclear.

Objective: This study aims to compare the clinical outcomes of patients following FFR-guided revascularisation for either ACS or stable angina (SA) and in particular focuses on the outcome of those with deferred revascularisation after FFR.

Methods: A meta-analysis of existing literature was performed. Outcomes including the rate of major adverse cardiovascular events (MACE), recurrent myocardial infarction (MI), mortality and unplanned revascularisation were analysed.

Results: A review of 937 records yielded 9 studies comparing 5457 patients, which were included in the analyses. Patients with ACS had a higher rate of recurrent MI (OR 1.81, p=0.02) and a strong trend towards more MACE and all-cause mortality compared with patients with SA when treated by an FFR-guided revascularisation strategy. Deferral of invasive therapy on the basis of FFR led to a higher rate of MACE (17.6% vs 7.3 %; p=0.004), recurrent MI (5.3% vs 1.5%, p=0.001) and target vessel revascularisation (16.4% vs 5.6 %; p=0.02) in patients with ACS, and a strong trend towards a higher cardiovascular mortality at follow-up when compared with patients with SA.

Conclusion: The event rate in patients with ACS is much higher than SA despite following an FFR-guided revascularisation strategy. Deferring revascularisation does not appear to be as safe for ACS as it is for SA using contemporary FFR cut-offs validated in SA. Refinement of the therapeutic strategy for patients with ACS with multivessel disease is needed to redress the balance.

Keywords: Fractional flow reserve; acute coronary syndrome; angiography.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) study flow diagram.
Figure 2
Figure 2
FFR-guided management in patients with ACS vs stable CAD. (A) Mace; (B) all-cause mortality; (C) recurrent MI; (D) unplanned revascularisation. ACS, acute coronary syndrome; FFR, fractional flow reserve; MI, myocardial infarction.
Figure 3
Figure 3
FFR guided deferral of PCI in patients with ACS and stable coronary artery disease (SCAD). (A) mace; (B) recurrent MI; (C) unplanned revascularisation; (D) cardiovascular mortality; (E) non-culprit vessel only versus both culprit and non-culprit vessel. ACS, acute coronary syndrome; FFR, fractional flow reserve; MI, myocardial infarction; PCI, percutaneous coronary intervention.
See this image and copyright information in PMC

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