Open AccessOutcomes Associated With Fractional Flow‐Guided Revascularization: A Meta‐analysis
Author(s) -
Bavry Anthony A.,
Elgendy Islam Y.,
Petersen John W.
Publication year - 2014
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22314
Subject(s) - medicine , revascularization , fractional flow reserve , cardiology , confidence interval , subgroup analysis , myocardial infarction , coronary artery disease , incidence (geometry) , relative risk , meta analysis , deferral , ischemia , surgery , coronary angiography , physics , optics , accounting , business
Background Deferral of revascularization for abnormal but nonischemic lesions is usually recommended; however, the long‐term outcome of this approach is not well known. Hypothesis Deferral of nonischemic lesions will be associated with a low frequency of adverse events. Methods A PubMed search of the MEDLINE database identified studies that reported clinical outcomes among patients who had fractional flow reserve‐guided revascularization. We further categorized studies into 2 subgroups: left main and non–left main coronary artery lesions. Baseline demographics and clinical outcome data were extracted by 3 independent reviewers. Fixed and random effects summary risk ratios were constructed using Mantel‐Haenszel and DerSimonian ‐Laird models, respectively. The primary outcome was the composite of death, myocardial infarction, and revascularization. Results From 741 potential studies, 17 were included in the meta‐analysis (n = 2975 participants), 8 in the left main subgroup (n = 595) and 9 studies (n = 2380) in non–left main subgroup. In the left main subgroup, the incidence of the composite outcome was 15.3% in the no‐ischemia/deferral group vs 14.3% in the ischemia/revascularization group (risk ratio [ RR ] = 1.13, 95% confidence interval [ CI ]: 0.76‐1.68, P = 0.54, I 2 = 3.7%). In the non–left main subgroup, the incidence of the composite outcome was 9.2% in the no‐ischemia/deferral group vs 18.8% in the ischemia/revascularization group (RR = 0.42, 95% CI: 0.34‐0.52, P < 0.0001, I 2 = 20.7%). Conclusions Patients with left main coronary disease had a relatively high incidence of adverse cardiovascular events, which was similar in both the deferral and revascularization groups. In patients with non–left main disease, ischemia was associated with worse outcomes despite revascularization.