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. 2022 Dec 5;55(6):442-451.
doi: 10.5090/jcs.22.072. Epub 2022 Nov 9.

The Impact of Fractional Flow Reserve on Clinical Outcomes after Coronary Artery Bypass Grafting: A Meta-analysis

Yoonjin Kang  1 , Heeju Hong  1 , Suk Ho Sohn  1 , Myoung-Jin Jang  2 , Ho Young Hwang  1
Affiliations

The Impact of Fractional Flow Reserve on Clinical Outcomes after Coronary Artery Bypass Grafting: A Meta-analysis

Yoonjin Kang et al. J Chest Surg. .

Abstract

Background: This meta-analysis was conducted to evaluate the effect of fractional flow reserve (FFR) on clinical outcomes after coronary artery bypass grafting (CABG).

Methods: Five online databases were searched for studies that (1) enrolled patients who underwent isolated CABG or CABG with aortic valve replacement and (2) demonstrated the effect of an FFR-guided strategy on major adverse cardiac events (MACE) after surgery based on a randomized controlled trial or adjusted analysis. MACE included cardiac death, acute myocardial infarction (MI), and repeated revascularization. The primary outcomes were all MACE outcomes and a composite of all-cause death and MI, and the secondary outcomes were the individual MACE outcomes. Publication bias was assessed using a funnel plot and the Egger test.

Results: Six articles (3 randomized and 3 non-randomized studies: n=1,027) were selected. MACE data were extracted from 4 studies. The pooled analyses showed that the risk of MACE was not significantly different between patients who underwent FFR-guided CABG and those who underwent angiography-guided CABG (hazard ratio [HR], 0.80; 95% CI, 0.57-1.12). However, the risk of the composite of death or MI was significantly lower in patients undergoing FFR-guided CABG (HR, 0.62; 95% CI, 0.41-0.94). The individual MACE outcomes were not significantly different between FFR-guided and angiography-guided CABG.

Conclusion: FFR-guided CABG might be beneficial in terms of the composite outcome of death or MI compared with angiography-guided CABG although data are limited.

Keywords: Coronary artery bypass grafting; Fractional flow reserve; Meta-analysis; Statistics.

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Conflict of interest statement

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Flow diagram based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses.
Fig. 2
Fig. 2
(A) Pooled analysis of the risk of the primary endpoint, major adverse cardiac events (MACE), after fractional flow reserve (FFR)-guided coronary artery bypass grafting (CABG) compared with angiography-guided CABG in randomized controlled trials (RCTs) and non-randomized studies (NRSs). The pooled estimates from the RCTs and NRSs showed that the decrease in MACE risk was not statistically significant in the FFR-guided CABG group. (B) A similar finding was obtained when the pooled analysis was performed for MACE or major adverse cardiac and cerebrovascular events (MACCE) in 6 studies. HR, hazard ratio; CI, confidence interval.
Fig. 3
Fig. 3
Pooled analysis of the risk of outcomes. (A) Composite of death or myocardial infarction (MI), (B) death, (C) MI, and (D) repeated revascularization after fractional flow reserve (FFR)-guided coronary artery bypass grafting (CABG) compared with angiography-guided CABG in randomized controlled trials (RCTs) and non-randomized studies (NRSs). The pooled estimates from the RCTs and NRSs showed that the risk of the composite of death or MI was significantly lower in the FFR-guided CABG group compared with the angiography-guided CABG group. HR, hazard ratio; CI, confidence interval. (Continued on next page).
Fig. 4
Fig. 4
A funnel plot and the Egger test for asymmetry suggested no publication bias for major adverse cardiac events (MACE) or major adverse cardiac and cerebrovascular events (MACCE). HR, hazard ratio.
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