Predictive value of post-percutaneous coronary intervention fractional flow reserve: a systematic review and meta-analysis

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AIMS: We aimed to investigate the relationship between post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) and clinical outcome using a systematic review with a study-level meta-analysis.

METHODS AND RESULTS: MEDLINE, Embase and CENTRAL were systematically searched for articles with clinical follow-up reporting mean or median final post-PCI FFR. The main outcome was a composite of MACE including all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR). Meta-regression analyses were performed of mean post-PCI FFR values. A total of 62 studies with 12 340 patients and 12 923 stented vessels were included, with follow-up ranging from 1 to 89 months. Post-PCI FFR was not continuously associated with the rate of 1-year MACE or 1-year TVR using meta-regression models accounting for heterogeneous follow-up lengths. For studies comparing high versus low post-PCI FFR, low post-PCI FFR was associated with high risk ratio for MACE (1.97 [95%CI:1.45-2.67]), all-cause death (1.59 [95%CI:1.08-2.34]), MI (3.18 [95%CI:1.84-5.50]), TVR (2.08 [95%CI:1.63-2.65]) and angina status (2.50 [95%CI:1.53-4.06]) using different optimal cut-off values spanning from 0.80 to 0.95.

CONCLUSION: We found no clear continuous association between post-PCI FFR and clinical outcomes in this systematic study-level meta-analysis. In a subset of studies investigating binary classification, high post-PCI FFR was associated with better clinical outcome than low post-PCI FFR.

Original languageEnglish
JournalEuropean heart journal. Quality of care & clinical outcomes
ISSN2058-1742
DOIs
Publication statusE-pub ahead of print - 26 Aug 2022

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© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

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