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The Role Of Fractional Flow Reserve In Coronary Artery Bypass Graft Surgery: A Meta-analysis.

Shruti Jayakumar, R. Bilkhu, S. Ayis, Justin L Nowell, R. Bogle, M. Jahangiri
Published 2020 · Medicine

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OBJECTIVES Fractional flow reserve (FFR) measures the drop in perfusion pressure across a stenosis, therefore representing its physiological effect on myocardial blood flow. Its use is widespread in percutaneous coronary interventions, though its role in coronary artery bypass graft (CABG) surgery remains uncertain. This systematic review and meta-analysis aims to evaluate current evidence on outcomes following FFR-guided CABG compared to angiography-guided CABG. METHODS A literature search was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify all relevant articles. Patient demographics and characteristics were extracted. The following outcomes were analysed: repeat revascularization, myocardial infarction (MI) and all-cause mortality. Pooled relative risks were analysed and their 95% confidence intervals (CIs) were estimated using random-effects models; P-value <0.05 was considered statistically significant. Heterogeneity was assessed with Cochran's Q score and quantified by I2 index. RESULTS Nine studies with 1146 patients (FFR: 574, angiography: 572) were included. There was no difference in MI or repeat revascularization between the 2 groups (relative risk 0.76, 95% CI 0.41-1.43; P = 0.40, and relative risk 1.28, 95% CI 0.75-2.19; P = 0.36, respectively). There was a significant reduction in all-cause mortality in the FFR-guided CABG group compared to angiography-guided CABG, which was not specifically cardiac related (relative risk 0.58, 95% CI 0.38-0.90; P = 0.02). CONCLUSIONS There was no reduction in repeat revascularization or postoperative MI with FFR. In this fairly small cohort, FFR-guided CABG provided a reduction in mortality, but this was not reported to be due to cardiac causes. There may be a role for FFR in CABG, but large-scale randomized trials are required to establish its value.
This paper references
10.1001/JAMA.1978.03290190031023
Coronary angiogram interpretation. Interobserver variability.
J. E. Galbraith (1978)
10.1016/0735-1097(90)90465-2
Accuracy of individual and panel visual interpretations of coronary arteriograms: implications for clinical decisions.
G. Beauman (1990)
10.1161/01.CIR.87.4.1354
Experimental Basis of Determining Maximum Coronary, Myocardial, and Collateral Blood Flow by Pressure Measurements for Assessing Functional Stenosis Severity Before and After Percutaneous Transluminal Coronary Angioplasty
N. Pijls (1993)
10.1161/01.CIR.92.11.3183
Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow.
N. Pijls (1995)
10.1016/S0735-1097(99)00126-6
ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions.
P. Scanlon (1999)
10.1016/S0002-8703(00)90316-8
Effect of variability in the interpretation of coronary angiograms on the appropriateness of use of coronary revascularization procedures
L. Leape (2000)
10.1161/01.CIR.103.24.2928
Fractional Flow Reserve to Determine the Appropriateness of Angioplasty in Moderate Coronary Stenosis A Randomized Trial
G. Bech (2001)
Fractional flow reserve to determine the appropriateness of angioplasty in moderate coronary stenosis
Bech (2001)
10.1002/SIM.1186
Quantifying heterogeneity in a meta-analysis.
J. Higgins (2002)
10.1016/S0003-4975(03)01022-1
Does competitive flow reduce internal thoracic artery graft patency?
J. Sabik (2003)
Percutaneous coronary intervention or bypass surgery in multivessel disease?
Botman (2004)
10.1007/s00380-005-0849-1
Coronary pressure measurement to determine treatment strategy for equivocal left main coronary artery lesions
S. Suemaru (2005)
10.1016/J.AHJ.2006.03.026
Clinical outcome in patients with intermediate or equivocal left main coronary artery disease after deferral of surgical revascularization on the basis of fractional flow reserve measurements.
M. Lindstaedt (2006)
10.1016/J.ATHORACSUR.2007.01.027
Does stenosis severity of native vessels influence bypass graft patency? A prospective fractional flow reserve-guided study.
C. Botman (2007)
10.1016/J.CCT.2006.04.004
Random-effects model for meta-analysis of clinical trials: an update.
R. Dersimonian (2007)
10.1016/J.JTCVS.2006.07.060
Angiographic evidence for reduced graft patency due to competitive flow in composite arterial T-grafts.
D. Pevni (2007)
10.1056/NEJMoa0807611
Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.
P. Tonino (2009)
10.1161/CIRCULATIONAHA.109.850073
Long-Term Clinical Outcome After Fractional Flow Reserve–Guided Treatment in Patients With Angiographically Equivocal Left Main Coronary Artery Stenosis
M. Hamilos (2009)
10.1136/bmj.b2535
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
D. Moher (2009)
10.1056/NEJMoa1205361
Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease.
B. De Bruyne (2012)
10.1155/2012/568950
Identification and Functional Annotation of Genome-Wide ER-Regulated Genes in Breast Cancer Based on ChIP-Seq Data
Min Ding (2012)
10.1155/2012/423627
The Stochastic Evolution of a Protocell: The Gillespie Algorithm in a Dynamically Varying Volume
T. Carletti (2012)
10.1161/CIRCULATIONAHA.113.002740
Fractional Flow Reserve–Guided Versus Angiography-Guided Coronary Artery Bypass Graft Surgery
G. Toth (2013)
10.1016/j.ahj.2015.06.024
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.
F. Zimmermann (2015)
10.1161/CIRCULATIONAHA.115.015549
Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes: Insights From the PREVENT IV Trial
R. Harskamp (2015)
10.1093/eurheartj/ehv452
Deferral vs. performance of percutaneous coronary intervention of functionally non-significant coronary stenosis: 15-year follow-up of the DEFER trial.
F. Zimmermann (2015)
10.1161/CIRCULATIONAHA.115.015549
Frequency and Predictors of Internal Mammary Artery Graft Failure and Subsequent Clinical Outcomes: Insights From the Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV Trial
R. Harskamp (2016)
10.1016/j.ijcard.2016.07.052
Impact of functional focal versus diffuse coronary artery disease on bypass graft patency.
Y. Shiono (2016)
10.1016/j.jacc.2018.09.043
Fractional Flow Reserve Versus Angiographically-Guided Coronary Artery Bypass Grafting.
A. Thuesen (2018)
10.21037/atm.2018.06.31
Physiologic assessment of moderate coronary lesions: a step towards complete revascularization in coronary artery bypass grafting.
John C Moscona (2018)
10.1161/CIRCINTERVENTIONS.117.006368
Six-Year Follow-Up of Fractional Flow Reserve-Guided Versus Angiography-Guided Coronary Artery Bypass Graft Surgery
S. Fournier (2018)
FUnctional Testing Underlying REvascularization: the FUTURE trial
Rioufol (2018)
10.1093/eurheartj/ehy394
2018 ESC/EACTS Guidelines on myocardial revascularization.
F. Neumann (2019)



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