Clinical relevance of impaired physiological assessment after percutaneous coronary intervention: a meta-analysis

Abstract

Background Despite optimal angiographic result of Percutaneous Coronary Intervention (PCI), residual disease at the site of the culprit lesion can lead to Major Adverse Cardiac Events (MACE) at follow-up [1]. Post-PCI physiological assessment can identify residual stenosis. Purpose The aim of this meta-analysis is to investigate data of studies with minimum follow-up of 6 months examining post-PCI physiological assessment in relation with long-term outcomes. Methods Studies were included in the meta-analysis after performing systematic search of the literature on 10th of January 2022. The primary endpoint was the incidence of MACE, Vessel-Orientated Cardiac Events (VOCE) or Target Vessel Failure (TVF). Secondary endpoints included the incidence of death, myocardial infarction (MI) and Target Vessel Revascularization (TVR). Results Low post-PCI FFR, reported in seven studies [2–8], including 4017 patients, was associated with an increased rate of the primary endpoint (HR 2.06; 95%-CI 1.37–3.08). One study reported about impaired post-PCI (instantaneous wave-free ratio) iFR in relation with MACE, showing a significant association (HR 3.38; 95%-CI 0.99–11.6) [9]. Low post-PCI QFR, reported in three studies [10–12], including 1181 patients, was associated with increased rate of VOCE (HR 3.02; 95%-CI 2.13–4.30). Combining data of all modalities, impaired physiological assessment showed an increased rate of the primary endpoint (HR 2.32; 95%-CI 1.71–3.16) and secondary endpoints including death (HR 1.35; 95%-CI 1.01–1.82), MI (HR 2.50; 95%-CI 1.36–4.58) and TVR (HR 2.88; 95%-CI 1.91–4.35). Conclusions Impaired post-PCI physiological assessment is associated with an increase in adverse cardiac events and individual endpoints including death, MI and TVR. Prospective studies are awaited whether physiology-based optimization of PCI results in better clinical outcome. Funding Acknowledgement Type of funding sources: None.

Angiography-Derived Fractional Flow Reserve in Coronary Assessment: Current Developments and Future Perspectives

“…Broad search terms (comprehensive search strategy in supplementary material Table S1) were used to identify the maximum number of studies eligible for inclusion from the electronic databases of PubMed, ScienceDirect, Cochrane and journals indexed in Radcliffe Cardiology. Various combinations of the following keywords were used: "coronary," "coronary physiology," "coronary circulation," "fractional flow reserve, myocardial," "FFR," and "wire-free" [44,45]. Systematic searching and analysis yielded 62 citations after the elimination of duplicates, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Figure 4).…”