Enezate T, et al. - This study compared percutaneous coronary intervention (PCI) outcomes when performed using guidance from fractional flow reserve (FFR) versus angiography (ANGIO). FFR-PCI versus ANGIO-PCI afforded lower in-hospital and follow-up myocardial infarction (MI) and major adverse cardiovascular events (MACE) rates, less PCI and lower procedure costs with no effect on procedure time, contrast volume or fluoroscopy time. Furthermore, FFR-PCI group had lower in-hospital target lesion revascularization (TLR) but this benefit was not present after 9 months.

Methods

• Researchers performed a search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from January, 2000 through December, 2016 for studies comparing FFR and ANGIO guided PCI.
• Myocardial infarction (MI), major adverse cardiovascular events (MACE), target lesion revascularization (TLR), and all-cause mortality were the clinical endpoints assessed during hospitalization and at follow-up (>9 months).
• Additional endpoints included number of PCIs performed, procedure cost, procedure time, contrast volume, and fluoroscopy time.

Results

• This analysis included 11 studies, with a total of 51,350 patients (age 65 years, 73% male).
• Findings demonstrated that FFR use was associated with significantly lower likelihood of MI during hospitalization (OR 0.54, 95% CI: 0.39 to 0.75, P = 0.0003) and at follow-up (OR 0.53, 95% CI: 0.40 to 0.70, P = 0.00001).
• Similarly, an association was also observed, of FFR-PCI with lower in-hospital MACE (OR 0.51, 95% CI: 0.37 to 0.70, P = 0.0001) and follow-up MACE (OR 0.63, 95% CI: 0.47 to 0.86, P = 0.004).
• Researchers observed that in the FFR-PCI group, in-hospital TLR was lower (OR 0.62, 95% CI: 0.40 to 0.97, P = 0.04), but not at follow-up (OR 0.83, 95% CI: 0.50 to 1.37,P = 0.46).
• They found no difference of in-hospital (OR 0.58, 95% CI: 0.31 to 1.09, P = 0.09) or follow-up all-cause mortality (OR 0.84, 95%CI: 0.59 to 1.20, P = 0.34).
• Data reported that FFR-PCI was associated with significantly less PCI (OR 0.04, 95% CI: 0.01 to 0.15, P = 0.00001) with lower procedure cost (Mean Difference -4.27, 95% CI: -6.61 to -1.92, P = 0.0004).
• However, researchers observed that there was no difference in procedure time (Mean Difference 0.79, 95% CI: -2.41 to 3.99,P = 0.63), contrast use (Mean Difference -8.28, 95% CI: -24.25 to 7.68, P = 0.31) or fluoroscopy time (Mean Difference 0.38, 95% CI: -2.54 to 3.31, P = 0.80).