Prognostic Implications of Fractional Flow Reserve After Coronary Stenting: A Systematic Review and Meta-analysis.

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Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_A504E50F4A2A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Prognostic Implications of Fractional Flow Reserve After Coronary Stenting: A Systematic Review and Meta-analysis.
Journal
JAMA network open
Author(s)
Hwang D., Koo B.K., Zhang J., Park J., Yang S., Kim M., Yun J.P., Lee J.M., Nam C.W., Shin E.S., Doh J.H., Chen S.L., Kakuta T., Toth G.G., Piroth Z., Johnson N.P., Pijls NHJ, Hakeem A., Uretsky B.F., Hokama Y., Tanaka N., Lim H.S., Ito T., Matsuo A., Azzalini L., Leesar M.A., Neleman T., van Mieghem N.M., Diletti R., Daemen J., Collison D., Collet C., De Bruyne B.
ISSN
2574-3805 (Electronic)
ISSN-L
2574-3805
Publication state
Published
Issued date
01/09/2022
Peer-reviewed
Oui
Volume
5
Number
9
Pages
e2232842
Language
english
Notes
Publication types: Journal Article ; Meta-Analysis ; Systematic Review
Publication Status: epublish
Abstract
Fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) is generally considered to reflect residual disease. Yet the clinical relevance of post-PCI FFR after drug-eluting stent (DES) implantation remains unclear.
To evaluate the clinical relevance of post-PCI FFR measurement after DES implantation.
MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant published articles from inception to June 18, 2022.
Published articles that reported post-PCI FFR after DES implantation and its association with clinical outcomes were included.
Patient-level data were collected from the corresponding authors of 17 cohorts using a standardized spreadsheet. Meta-estimates for primary and secondary outcomes were analyzed per patient and using mixed-effects Cox proportional hazard regression with registry identifiers included as a random effect. All processes followed the Preferred Reporting Items for Systematic Review and Meta-analysis of Individual Participant Data.
The primary outcome was target vessel failure (TVF) at 2 years, a composite of cardiac death, target vessel myocardial infarction (TVMI), and target vessel revascularization (TVR). The secondary outcome was a composite of cardiac death or TVMI at 2 years.
Of 2268 articles identified, 29 studies met selection criteria. Of these, 28 articles from 17 cohorts provided data, including a total of 5277 patients with 5869 vessels who underwent FFR measurement after DES implantation. Mean (SD) age was 64.4 (10.1) years and 4141 patients (78.5%) were men. Median (IQR) post-PCI FFR was 0.89 (0.84-0.94) and 690 vessels (11.8%) had a post-PCI FFR of 0.80 or below. The cumulative incidence of TVF was 340 patients (7.2%), with cardiac death or TVMI occurring in 111 patients (2.4%) at 2 years. Lower post-PCI FFR significantly increased the risk of TVF (adjusted hazard ratio [HR] per 0.01 FFR decrease, 1.04; 95% CI, 1.02-1.05; P < .001). The risk of cardiac death or MI also increased inversely with post-PCI FFR (adjusted HR, 1.03; 95% CI, 1.00-1.07, P = .049). These associations were consistent regardless of age, sex, the presence of hypertension or diabetes, and clinical diagnosis.
Reduced FFR after DES implantation was common and associated with the risks of TVF and of cardiac death or TVMI. These results indicate the prognostic value of post-PCI physiologic assessment after DES implantation.
Keywords
Coronary Angiography, Death, Drug-Eluting Stents/adverse effects, Female, Fractional Flow Reserve, Myocardial/physiology, Humans, Male, Middle Aged, Myocardial Infarction/etiology, Percutaneous Coronary Intervention/adverse effects, Prognosis, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
04/10/2022 10:38
Last modification date
19/12/2023 7:24
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