Prognostic differences between physiology-guided percutaneous coronary intervention and optimal medical therapy in coronary artery disease: A systematic review and meta-analysis
Background: Intracoronary physiology, particularly fractional flow reserve (FFR), has been used as a guide for revascularization for patients with coronary artery disease (CAD). The optimal treatment in the physiological grey-zone area has been unclear and remains subject to ongoing debate. Methods:...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | American Heart Journal Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602224000053 |
| _version_ | 1827359073292517376 |
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| author | Utsho Islam, MB Muhammad Sabbah, MD, PhD Burcu T. Özbek, MD Jasmine M. Madsen, MD Jacob T. Lønborg, MD, PhD, DMSc Thomas Engstrøm, MD, PhD, DMSc |
| author_facet | Utsho Islam, MB Muhammad Sabbah, MD, PhD Burcu T. Özbek, MD Jasmine M. Madsen, MD Jacob T. Lønborg, MD, PhD, DMSc Thomas Engstrøm, MD, PhD, DMSc |
| author_sort | Utsho Islam, MB |
| collection | DOAJ |
| description | Background: Intracoronary physiology, particularly fractional flow reserve (FFR), has been used as a guide for revascularization for patients with coronary artery disease (CAD). The optimal treatment in the physiological grey-zone area has been unclear and remains subject to ongoing debate. Methods: We conducted a systematic review of randomized controlled trials and observational studies comparing the prognostic effect of percutaneous coronary revascularization (PCI) and optimal medical therapy (OMT) in patients with CAD. Studies were identified by medical literature databases. The outcomes of interest were major adverse cardiac events (MACE) and its components, death, myocardial infarction (MI), and repeat revascularization. Results: A total of 16 studies with 27,451 patients were included. The pooled analysis demonstrated that PCI was associated with a prognostic advantage over OMT in patients with FFR value ≤0.80 (RR: 0.64, 95 % CI: 0.45–0.90, p < 0.01). Patients with an FFR value >0.80 were shown to benefit more from OMT (RR 1.38, 95 % CI 1.24–1.53, p < 0.01). The analysis also showed that there was no significant difference in MACE in the grey-zone area (FFR 0.75–0.80) (RR 0.64, 95 % CI: 0.35–1.16, p = 0.14), but a significant reduction in repeat revascularization (RR 0.54, 95 % CI, 0.31–0.91, p < 0.01) when patients were treated with PCI. Conclusions: Among patients with CAD and FFR values >0.80, OMT was associated with favorable outcomes over PCI in reducing the risk of MACE. However, among patients with FFR values ≤0.80, revascularization was superior in terms of reducing MACE. The available evidence supports the guideline-recommended use of an FFR cut-off of ≤0.80. |
| first_indexed | 2024-03-08T06:20:24Z |
| format | Article |
| id | doaj.art-7356ec18c60f433ea056f4b01f348141 |
| institution | Directory Open Access Journal |
| issn | 2666-6022 |
| language | English |
| last_indexed | 2024-03-08T06:20:24Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Heart Journal Plus |
| spelling | doaj.art-7356ec18c60f433ea056f4b01f3481412024-02-04T04:46:48ZengElsevierAmerican Heart Journal Plus2666-60222024-02-0138100362Prognostic differences between physiology-guided percutaneous coronary intervention and optimal medical therapy in coronary artery disease: A systematic review and meta-analysisUtsho Islam, MB0Muhammad Sabbah, MD, PhD1Burcu T. Özbek, MD2Jasmine M. Madsen, MD3Jacob T. Lønborg, MD, PhD, DMSc4Thomas Engstrøm, MD, PhD, DMSc5Corresponding author.; The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, DenmarkThe Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, DenmarkThe Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, DenmarkThe Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, DenmarkThe Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, DenmarkThe Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, DenmarkBackground: Intracoronary physiology, particularly fractional flow reserve (FFR), has been used as a guide for revascularization for patients with coronary artery disease (CAD). The optimal treatment in the physiological grey-zone area has been unclear and remains subject to ongoing debate. Methods: We conducted a systematic review of randomized controlled trials and observational studies comparing the prognostic effect of percutaneous coronary revascularization (PCI) and optimal medical therapy (OMT) in patients with CAD. Studies were identified by medical literature databases. The outcomes of interest were major adverse cardiac events (MACE) and its components, death, myocardial infarction (MI), and repeat revascularization. Results: A total of 16 studies with 27,451 patients were included. The pooled analysis demonstrated that PCI was associated with a prognostic advantage over OMT in patients with FFR value ≤0.80 (RR: 0.64, 95 % CI: 0.45–0.90, p < 0.01). Patients with an FFR value >0.80 were shown to benefit more from OMT (RR 1.38, 95 % CI 1.24–1.53, p < 0.01). The analysis also showed that there was no significant difference in MACE in the grey-zone area (FFR 0.75–0.80) (RR 0.64, 95 % CI: 0.35–1.16, p = 0.14), but a significant reduction in repeat revascularization (RR 0.54, 95 % CI, 0.31–0.91, p < 0.01) when patients were treated with PCI. Conclusions: Among patients with CAD and FFR values >0.80, OMT was associated with favorable outcomes over PCI in reducing the risk of MACE. However, among patients with FFR values ≤0.80, revascularization was superior in terms of reducing MACE. The available evidence supports the guideline-recommended use of an FFR cut-off of ≤0.80.http://www.sciencedirect.com/science/article/pii/S2666602224000053Coronary artery diseaseFractional flow reserveOptimal medical therapyPercutaneous coronary interventionRevascularization |
| spellingShingle | Utsho Islam, MB Muhammad Sabbah, MD, PhD Burcu T. Özbek, MD Jasmine M. Madsen, MD Jacob T. Lønborg, MD, PhD, DMSc Thomas Engstrøm, MD, PhD, DMSc Prognostic differences between physiology-guided percutaneous coronary intervention and optimal medical therapy in coronary artery disease: A systematic review and meta-analysis American Heart Journal Plus Coronary artery disease Fractional flow reserve Optimal medical therapy Percutaneous coronary intervention Revascularization |
| title | Prognostic differences between physiology-guided percutaneous coronary intervention and optimal medical therapy in coronary artery disease: A systematic review and meta-analysis |
| title_full | Prognostic differences between physiology-guided percutaneous coronary intervention and optimal medical therapy in coronary artery disease: A systematic review and meta-analysis |
| title_fullStr | Prognostic differences between physiology-guided percutaneous coronary intervention and optimal medical therapy in coronary artery disease: A systematic review and meta-analysis |
| title_full_unstemmed | Prognostic differences between physiology-guided percutaneous coronary intervention and optimal medical therapy in coronary artery disease: A systematic review and meta-analysis |
| title_short | Prognostic differences between physiology-guided percutaneous coronary intervention and optimal medical therapy in coronary artery disease: A systematic review and meta-analysis |
| title_sort | prognostic differences between physiology guided percutaneous coronary intervention and optimal medical therapy in coronary artery disease a systematic review and meta analysis |
| topic | Coronary artery disease Fractional flow reserve Optimal medical therapy Percutaneous coronary intervention Revascularization |
| url | http://www.sciencedirect.com/science/article/pii/S2666602224000053 |
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