Key result
Revascularization significantly reduced the risk of major adverse cardiac events compared to deferral in patients with grey zone FFR (HR 0.65; 95% CI 0.45-0.93; P=0.02).
Why the study?
It remained uncertain whether revascularization should be performed or deferred for patients with coronary stenosis and grey zone FFR values.
Does revascularization reduce major adverse cardiac events in patients with coronary stenosis and grey zone FFR compared to deferral?
Meta-Analysis (n=2,683)
Does revascularization reduce major adverse cardiac events in patients with coronary stenosis and grey zone FFR compared to deferral?
Revascularization for coronary stenosis with grey zone FFR values reduces MACE and TVR compared to deferral, though it does not significantly impact hard endpoints like death or MI.
Supports revascularization over deferral in grey-zone FFR to reduce MACE; extends FFR threshold evidence and informs guideline updates.
We searched PubMed, EMBASE, Cochrane Library, and Web of Science for studies using fractional flow reserve (FFR) to determine whether revascularization should be performed or deferred for patients with coronary stenosis and grey zone FFR. Meta-analysis was performed using the generic inverse variance method, and hazard ratios (HR) were synthesized with a random-effects model. Of 2766 records, 7 nonrandomized studies including 2683 patients were selected. The pooled results demonstrated, during a median follow-up of 32 months, that revascularization significantly reduced the risk of major adverse cardiac events (MACE; 7 studies: HR [95% confidence interval, CI]: 0.65 [0.45-0.93], P = .02) and target vessel revascularization (TVR; 4 studies: HR [95% CI]: 0.52 [0.36-0.76], P < .01). Whereas revascularization was not significantly superior in terms of all-cause death (3 studies: HR [95% CI]: 0.56 [0.26-1.22], P = .14), cardiac death (2 studies: HR [95% CI]: 0.57 [0.16-2.01], P = .38), myocardial infarction (MI; 4 studies: HR [95% CI]: 1.03 [0.26-4.03]), and all-cause death or MI (3 studies: HR [95% CI]: 0.66 [0.20-2.19], P = .50). Therefore, revascularization appeared to be superior to deferral for patients with grey zone FFR in MACE and TVR, while hard end points did not show such significance. This work was registered in PROSPERO (CRD42019118432).
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Du et al. (2019) conducted a meta-analysis in Coronary stenosis with grey zone fractional flow reserve (FFR) (n=2,683). Revascularization vs. Deferral was evaluated on Major adverse cardiac events (MACE) (HR 0.65, 95% CI 0.45-0.93, p=.02). Revascularization significantly reduced the risk of major adverse cardiac events compared to deferral in patients with grey zone FFR (HR 0.65; 95% CI 0.45-0.93; P=0.02).
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