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Meta-Analysis
. 2022 Feb;99(3):730-735.
doi: 10.1002/ccd.29864. Epub 2021 Jul 7.

Influence of fractional flow reserve on grafts patency: Systematic review and patient-level meta-analysis

Gabor G Toth  1 , Carlos Collet  2 , Anne Langhoff Thuesen  3   4 , Takuya Mizukami  2   5 , Filip Casselman  6 , Lars Peter Riber  3 , Frank Van Praet  6 , Anders Junker  4 , Sakura Nagumo  2   7 , Bernard De Bruyne  2   8 , Lisette Okkels Jensen  4 , Emanuele Barbato  2   9
Affiliations
Meta-Analysis

Influence of fractional flow reserve on grafts patency: Systematic review and patient-level meta-analysis

Gabor G Toth et al. Catheter Cardiovasc Interv. 2022 Feb.

Abstract

Objective: To investigate the impact of invasive functional guidance for coronary artery bypass graft surgery (CABG) on graft failure.

Background: Data on the impact of fractional flow reserve (FFR) in guiding CABG are still limited.

Methods: Systematic review and individual patient data meta-analysis were performed. Primary objective was the risk of graft failure, stratified by FFR. Risk estimates are reported as odds ratios (ORs) derived from the aggregated data using random-effects models. Individual patient data were analyzed using mixed effect model to assess relationship between FFR and graft failure. This meta-analysis is registered in PROSPERO (CRD42020180444).

Results: Four prospective studies comprising 503 patients referred for CABG, with 1471 coronaries, assessed by FFR were included. Graft status was available for 1039 conduits at median of 12.0 [IQR 6.6; 12.0] months. Risk of graft failure was higher in vessels with preserved FFR (OR 5.74, 95% CI 1.71-19.29). Every 0.10 FFR units decrease in the coronaries was associated with 56% risk reduction of graft failure (OR 0.44, 95% CI 0.34 to 0.59). FFR cut-off to predict graft failure was 0.79.

Conclusion: Surgical grafting of coronaries with functionally nonsignificant stenoses was associated with higher risk of graft failure.

Keywords: coronary artery bypass surgery; fractional flow reserve; graft patency.

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Conflict of interest statement

GT reports receiving research grants from Boston Scientific, Terumo and Abbott Vascular; and consultancy fees from Abbott Vascular, Biotronik and Medtronic. CC reports receiving research grants from Biosensor, Heart Flow Inc. and Abbott Vascular; and consultancy fees from Heart Flow Inc. and Philips Volcano. BDB reports receiving consultancy fees on his behalf from Boston Scientific, Abbott, and Opsens. EB receives speaker's fees from Abbott Vascular, Boston Scientific, General Electrics, and Opsens outside the present work. Other authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Risk of graft failure in vessels with preserved and abnormal FFR. Risk of graft failure according to functional status of the native coronary arteries prior coronary bypass surgery. Preserved and abnormal FFR were defined according to each study protocol. Odds ratio is presented on log scale [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Probability of graft failure in function of FFR values. Adjusted logistic regression analysis showed significant association between FFR, as a continuous variable, and graft failure. There was a 56% reduction in the risk of graft failure for every 0.10 decrease in FFR units in the native coronary artery [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Sankey diagram with subsequent nodes of trial, target vessel, conduit type, FFR values and graft patency. Visualization of individual patient‐level analysis with 260 bypass anastomoses showing the target vessel, conduit type, range of FFR and graft patency at follow‐up. Diag, diagonal; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 4
FIGURE 4
Kaplan Meier curves comparing FFR‐guided versus angiography‐guided CABG. There was no difference in the rate of major adverse cardiac and cerebral events between FFR‐guided versus angiography‐guided CABG [Color figure can be viewed at wileyonlinelibrary.com]
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