One‑year clinical outcome of angiography, fractional flow reserve and instantaneous wave‑free ratio guided percutaneous coronary intervention: A PRISMA‑compliant meta‑analysis

Baumann,Stefan; Mueller,Klara  S. E.; Hetjens,Svetlana; Eder,Frederik; Schaefer,Antonia  C.; Becher,Tobias; Borggrefe,Martin; Akin,Ibrahim; Loßnitzer,Dirk

doi:10.3892/etm.2019.7156

One‑year clinical outcome of angiography, fractional flow reserve and instantaneous wave‑free ratio guided percutaneous coronary intervention: A PRISMA‑compliant meta‑analysis

Authors:
- Stefan Baumann
- Klara S. E. Mueller
- Svetlana Hetjens
- Frederik Eder
- Antonia C. Schaefer
- Tobias Becher
- Martin Borggrefe
- Ibrahim Akin
- Dirk Loßnitzer
View Affiliations

Affiliations: First Department of Medicine‑Cardiology, University Medical Centre Mannheim, University of Heidelberg, D‑68167 Mannheim, Germany, Medical Faculty Mannheim, Department of Medical Statistics, University of Heidelberg, D‑68167 Mannheim, Germany, DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, D‑68167 Mannheim, Germany
Published online on: January 7, 2019 https://doi.org/10.3892/etm.2019.7156
Pages: 1939-1951

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study aimed to compare the clinical outcome of patients with coronary artery disease (CAD) who underwent a revascularization using conventional coronary angiography or a physiologically guided revascularization with Fractional Flow Reserve (FFR). Furthermore, outcomes in FFR guided percutaneous coronary intervention (PCI) and instantaneous wave‑free ratio (iFR) guided PCI were compared. The analysis was performed for reported outcomes at a 1‑year follow‑up. After searching PubMed, EMBASE, and Web of Science for suitable publications, a total of 15,880 subjects were included. Comparing angiography guided and FFR guided PCI showed no significant difference in major adverse cardiac events [odds ratio (OR), 0.78; 95% confidence interval (CI), 0.59‑1.04; P=0.09; I²=73%], death from any cause (OR, 0.74; 95% CI, 0.46‑1.18; P=0.20; I²=74%), myocardial infarction (OR, 0.93; 95% CI, 0.81‑1.07; P=0.31; I²=0%) or unplanned revascularization (OR, 0.71; 95% CI, 0.41‑1.23; P=0.22; I²=79%). In addition, no significant difference could be found between iFR and FFR guided PCI for major adverse cardiac events (OR, 0.97; 95% CI; 0.76‑1.23; P=0.81; I²=0%), death from any cause (OR, 0.66; 95% CI, 0.40‑1.11; P=0.12; I²=0%), myocardial infarction (OR, 0.83; 95% CI, 0.56‑1.24; P=0.37) or unplanned revascularization (OR, 1.16; 95% CI, 0.85‑1.58; P=0.34; I²=16%). Overall, there was a tendency towards better outcomes of FFR in all four clinical endpoints compared with angiography guiding of PCI, and furthermore iFR showed no significant inferiority when compared to FFR in said clinical endpoints. When conducting a network meta‑analysis, the results confirmed a non‑inferiority of iFR compared to angiography guided revascularization.

View Figures

View References

1	Pijls NH, van Schaardenburgh P, Manoharan G, Boersma E, Bech JW, van't Veer M, Bär F, Hoorntje J, Koolen J, Wijns W and de Bruyne B: Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER study. J Am Coll Cardiol. 49:2105–2111. 2007. View Article : Google Scholar : PubMed/NCBI
2	De Bruyne B, Pijls NH, Kalesan B, Barbato E, Tonino PA, Piroth Z, Jagic N, Möbius-Winkler S, Rioufol G, Witt N, et al: Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 367:991–1001. 2012. View Article : Google Scholar : PubMed/NCBI
3	Authors/Task Force members, ; Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, et al: 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 35:2541–2619. 2014. View Article : Google Scholar : PubMed/NCBI
4	Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, et al: 2011 ACCF/AHA/SCAI Guideline for percutaneous coronary intervention. A report of the American college of cardiology foundation/American heart association task force on practice guidelines and the society for cardiovascular angiography and interventions. Circulation. 124:e574–e651. 2011.PubMed/NCBI
5	Sen S, Escaned J, Malik IS, Mikhail GW, Foale RA, Mila R, Tarkin J, Petraco R, Broyd C, Jabbour R, et al: Development and validation of a new adenosine-independent index of stenosis severity from coronary wave-intensity analysis: Results of the ADVISE (ADenosine Vasodilator Independent Stenosis Evaluation) study. J Am Coll Cardiol. 59:1392–1402. 2012. View Article : Google Scholar : PubMed/NCBI
6	Sen S, Asrress KN, Nijjer S, Petraco R, Malik IS, Foale RA, Mikhail GW, Foin N, Broyd C, Hadjiloizou N, et al: Diagnostic classification of the instantaneous wave-free ratio is equivalent to fractional flow reserve and is not improved with adenosine administration. Results of CLARIFY (Classification Accuracy of Pressure-Only Ratios Against Indices Using Flow Study). J Am Coll Cardiol. 61:1409–1420. 2013. View Article : Google Scholar : PubMed/NCBI
7	Petraco R, Al-Lamee R, Gotberg M, Sharp A, Hellig F, Nijjer SS, Echavarria-Pinto M, van de Hoef TP, Sen S, Tanaka N, et al: Real-time use of instantaneous wave-free ratio: Results of the ADVISE in-practice: An international, multicenter evaluation of instantaneous wave-free ratio in clinical practice. Am Heart J. 168:739–748. 2014. View Article : Google Scholar : PubMed/NCBI
8	Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van't Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, et al: Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 360:213–224. 2009. View Article : Google Scholar : PubMed/NCBI
9	Puymirat E, Peace A, Mangiacapra F, Conte M, Ntarladimas Y, Bartunek J, Vanderheyden M, Wijns W, De Bruyne B and Barbato E: Long-term clinical outcome after fractional flow reserve-guided percutaneous coronary revascularization in patients with small-vessel disease. Circ Cardiovasc Interv. 5:62–68. 2012. View Article : Google Scholar : PubMed/NCBI
10	Li J, Elrashidi MY, Flammer AJ, Lennon RJ, Bell MR, Holmes DR, Bresnahan JF, Rihal CS, Lerman LO and Lerman A: Long-term outcomes of fractional flow reserve-guided vs. angiography-guided percutaneous coronary intervention in contemporary practice. Eur Heart J. 34:1375–1383. 2013. View Article : Google Scholar : PubMed/NCBI
11	Chen SL, Ye F, Zhang JJ, Xu T, Tian NL, Liu ZZ, Lin S, Shan SJ, Ge Z, You W, et al: Randomized Comparison of ffr-guided and angiography-guided provisional stenting of true coronary bifurcation lesions: The DKCRUSH-VI Trial (Double Kissing Crush Versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions VI). JACC Cardiovasc Interv. 8:536–546. 2015. View Article : Google Scholar : PubMed/NCBI
12	Layland J, Oldroyd KG, Curzen N, Sood A, Balachandran K, Das R, Junejo S, Ahmed N, Lee MM, Shaukat A, et al: Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction: The British Heart Foundation FAMOUS-NSTEMI randomized trial. Eur Heart J. 36:100–111. 2015. View Article : Google Scholar : PubMed/NCBI
13	Park SH, Jeon KH, Lee JM, Nam CW, Doh JH, Lee BK, Rha SW, Yoo KD, Jung KT, Cho YS, et al: Long-term clinical outcomes of fractional flow reserve-guided versus routine drug-eluting stent implantation in patients with intermediate coronary stenosis: Five-year clinical outcomes of DEFER-DES trial. Circ Cardiovasc Interv. 8:e0024422015. View Article : Google Scholar : PubMed/NCBI
14	De Backer O, Biasco L, Lønborg J, Pedersen F, Holmvang L, Kelbaek H, Arnous S, Saunamäki K, Helqvist S, Kastrup J, et al: Long-term outcome of FFR-guided PCI for stable coronary artery disease in daily clinical practice: A propensity score-matched landmark analysis. EuroIntervention. 11:e1257–e1266. 2016. View Article : Google Scholar : PubMed/NCBI
15	Davies JE, Sen S, Dehbi HM, Al-Lamee R, Petraco R, Nijjer SS, Bhindi R, Lehman SJ, Walters D, Sapontis J, et al: Use of the instantaneous wave-free ratio or fractional flow reserve in PCI. N Engl J Med. 376:1824–1834. 2017. View Article : Google Scholar : PubMed/NCBI
16	Götberg M, Christiansen EH, Gudmundsdottir IJ, Sandhall L, Danielewicz M, Jakobsen L, Olsson SE, Öhagen P, Olsson H, Omerovic E, et al: Instantaneous wave-free ratio versus fractional flow reserve to guide PCI. N Engl J Med. 376:1813–1823. 2017. View Article : Google Scholar : PubMed/NCBI
17	Higgins JP, Thompson SG, Deeks JJ and Altman DG: Measuring inconsistency in meta-analyses. BMJ. 327:557–560. 2003. View Article : Google Scholar : PubMed/NCBI
18	Pijls NH, De Bruyne B, Peels K, Van Der Voort PH, Bonnier HJ, Bartunek J Koolen JJ and Koolen JJ: Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 334:1703–1708. 1996. View Article : Google Scholar : PubMed/NCBI
19	Zimmermann FM, De Bruyne B, Pijls NH, Desai M, Oldroyd KG, Park SJ, Reardon MJ, Wendler O, Woo J, Yeung AC and Fearon WF: Rationale and design of the Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) 3 Trial: A comparison of fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass graft surgery in patients with multivessel coronary artery disease. Am Heart J. 170:619–626.e2. 2015. View Article : Google Scholar : PubMed/NCBI
20	Enezate T, Omran J, Al-Dadah AS, Alpert M, White CJ, Abu-Fadel M, Aronow H, Cohen M, Aguirre F, Patel M and Mahmud E: Fractional flow reserve versus angiography guided percutaneous coronary intervention: An updated systematic review. Catheter Cardiovasc Interv. Oct 5–2017.(Epub ahead of print).
21	Zhang D, Lv S, Song X, Yuan F, Xu F, Zhang M, Yan S and Cao X: Fractional flow reserve versus angiography for guiding percutaneous coronary intervention: A meta-analysis. Heart. 101:455–462. 2015. View Article : Google Scholar : PubMed/NCBI
22	Bundhun PK, Yanamala CM and Huang F: Comparing the adverse clinical outcomes associated with fraction flow reserve-guided versus angiography-guided percutaneous coronary intervention: A systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord. 16:2492016. View Article : Google Scholar : PubMed/NCBI