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Network meta-analysis comparing iFR versus FFR versus coronary angiography to drive coronary revascularization.

Abstract：

AIMS:Instantaneous free-wave ratio (iFR) has been recently demonstrated non-inferior to fractional flow reserve (FFR) to drive coronary revascularization; however, no study has compared iFR versus coronary angiography (CA). We performed a network meta-analysis to evaluate efficacy and safety of iFR- versus CA-guided strategy. METHODS AND RESULTS:We searched for randomized trials and studies with propensity score matching in The Cochrane Collaboration Central Register of Controlled Trials, EMBASE, and MEDLINE/Pubmed. CA, FFR, and iFR were the three competitive arms, MACE (a composite endpoint of death, myocardial infarction [MI], and target vessel revascularization [TVR]) was the primary endpoint, while its single components the secondary ones. Subgroup analysis was performed for patients presenting with stable coronary artery disease. Eight studies were selected: 4126 patients were evaluated with FFR, 2160 with iFR, and 2214 with CA, acute coronary syndrome (ACS) was the most frequent admission diagnosis. After 12 months, rates of MACE and all-cause death did not differ between groups (respectively OR 1.04 and OR 0.86 for iFR vs FFR). Both FFR and iFR reduced TVR compared to CA (respectively OR 0.68 and OR 0.70). In patients with stable CAD both FFR and iFR reduced risk of subsequent MI compared to CA (respectively OR 0.66 and OR 0.79). CONCLUSION:Compared to CA alone, both FFR and iFR are safe and effective in guiding coronary revascularization at 12 months. In patients with stable CAD, both FFR and iFR-guided revascularization reduce the risk of subsequent MI at 12 months.

journal_name

J Interv Cardiol

journal_title

Journal of interventional cardiology

authors

Verardi R,Fioravanti F,Barbero U,Conrotto F,Omedè P,Montefusco A,Moretti C,D'Amico M,Rinaldi M,Escaned J,D'Ascenzo F

doi

10.1111/joic.12551

subject

Has Abstract

pub_date

2018-12-01 00:00:00

pages

725-730

issue

6

eissn

0896-4327

issn

1540-8183

journal_volume

31

pub_type

杂志文章,meta分析

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