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- Title
Prognostic Implications of Fractional Flow Reserve After Coronary Stenting: A Systematic Review and Meta-analysis.
- Authors
Hwang, Doyeon; Koo, Bon-Kwon; Zhang, Jinlong; Park, Jiesuck; Yang, Seokhun; Kim, Minsang; Yun, Jun Pil; Lee, Joo Myung; Nam, Chang-Wook; Shin, Eun-Seok; Doh, Joon-Hyung; Chen, Shao-Liang; Kakuta, Tsunekazu; Toth, Gabor G.; Piroth, Zsolt; Johnson, Nils P.; Pijls, Nico H. J.; Hakeem, Abdul; Uretsky, Barry F.; Hokama, Yohei
- Abstract
Key Points: Question: What is the clinical relevance of fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) with a drug-eluting stent? Findings: In this systematic review and individual patient-level meta-analysis, low post-PCI FFR was common and demonstrated a significant and inverse association with target vessel failure. This association remained consistent for the risk of cardiac death or target vessel myocardial infarction. Meaning: These results support the importance of post-PCI physiologic assessment and the role of post-PCI FFR as a procedural quality metric. This systematic review and meta-analysis examines clinical outcomes associated with low fractional flow reserve measures after percutaneous coronary interventions with drug-eluting stents. Importance: 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. Objective: To evaluate the clinical relevance of post-PCI FFR measurement after DES implantation. Data Sources: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant published articles from inception to June 18, 2022. Study Selection: Published articles that reported post-PCI FFR after DES implantation and its association with clinical outcomes were included. Data Extraction and Synthesis: 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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.
- Subjects
MYOCARDIAL infarction risk factors; MEDICAL databases; HYPERTENSION; PERCUTANEOUS coronary intervention; META-analysis; MEDICAL information storage &; retrieval systems; CONFIDENCE intervals; DRUG-eluting stents; SYSTEMATIC reviews; LOG-rank test; AGE distribution; REGRESSION analysis; DIABETES; HYPERCHOLESTEREMIA; ACUTE coronary syndrome; CORONARY circulation; TREATMENT effectiveness; RISK assessment; SEX distribution; CORONARY artery disease; DESCRIPTIVE statistics; MYOCARDIAL revascularization; KAPLAN-Meier estimator; MEDLINE; DATA analysis software; PROPORTIONAL hazards models
- Publication
JAMA Network Open, 2022, Vol 5, Issue 9, pe2232842
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.32842