title: Meta-analysis of deferral versus performance of coronary intervention based on coronary pressure-derived fractional flow reserve.
abstract: Fractional flow reserve (FFR) has been proposed as the gold standard to assess functional severity of coronary artery stenosis and to stratify which lesions should be subjected to intervention (percutaneous coronary intervention [PCI]). A systematic review was performed in MEDLINE and EMBASE including studies indexed until November 2013 that used FFR for deferral or performance of PCI. Outcomes of interest were death, acute myocardial infarction (AMI), and new revascularization (RV). Nineteen studies were included, totaling 3,097 patients (3,796 lesions). Mean follow-up was 21.2 months. In indirect comparisons, FFR-PCI and FFR-defer groups had similar death (2.2% vs 2.0%, respectively, p = 0.86) and AMI rates (1.9% vs 1.9%, respectively, p = 1.00). RV rates were higher in the FFR-PCI group (14.0% vs 4.4%, p = 0.002). Direct comparisons (2-arm trials) also showed no differences in death (odds ratio [OR] 1.86 [95% CI 0.81 to 4.27], I(2) = 11.5, p = 0.14) and AMI rates (OR 0.75 [95% CI 0.21 to 2.69], I(2) = 47.1, p = 0.66); RV rates were again higher in the FFR-PCI (OR 3.10 [95% CI 1.25 to 7.70], I(2) = 72.2, p = 0.015). Meta-regression suggests influence of male gender on RV rates (β = 0.058, p = 0.026). In conclusion, deferral of PCI based on FFR is a safe strategy. Considerable heterogeneity was observed, however.
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Serviço de Hemodinâmica, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. Electronic address: ramosnas@gmail.com.
authors.forename: Bruno R
authors.initials: BR
authors.lastname: Nascimento
authors.affiliation: Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Ana Flávia L
authors.initials: AF
authors.lastname: Belfort
authors.affiliation: Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Fernando Augusto C
authors.initials: FA
authors.lastname: Macedo
authors.affiliation: Serviço de Hemodinâmica, Hospital Santa Helena, Cabo Frio, Rio de Janeiro, Brazil.
authors.forename: Fernando M
authors.initials: FM
authors.lastname: Sant'Anna
authors.affiliation: Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Gabriel T R
authors.initials: GT
authors.lastname: Pereira
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, Ohio.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Costa
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Antonio L P
authors.initials: AL
authors.lastname: Ribeiro
mesh_terms: D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016896:Treatment Outcome