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May 18, 2024The American Journal of CardiologyOpen Access

Assessment of Coronary Stenoses for Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis of Randomized Trials

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Key result

Quantitative flow ratio (QFR) to guide PCI decisions was associated with a decreased risk of MACE compared with coronary angiography (RR 0.68; 95% CI 0.56-0.82).

Why the study?

Evidence regarding the comparative efficacy of different methods to determine the significance of coronary stenoses in the catheterization laboratory was lacking.

Do physiological or imaging methods (QFR, FFR, iFR, intravascular imaging) reduce MACE compared to coronary angiography in patients considered for PCI?

Population

16,333 participants with greater than 30% stenoses considered for PCI across 15 randomized trials

Comparison

Methods guiding the decision to perform PCI (QFR, FFR, iFR, intravascular imaging, CA)

Design

Systematic review and frequentist random-effects network meta-analysis

Follow-up

Mean weighted follow-up of 34 months

Authors

MDMarc-André d’EntremontDTDenise TiongBSBehnam Sadeghirad

Discussion

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Overview

QFR may warrant consideration for PCI guidance to lower MACE; extends network meta-analysis evidence beyond FFR and iFR.

Study Design

Type

Meta-Analysis (n=16,333)

Structured PICO

Do physiological or imaging methods (QFR, FFR, iFR, intravascular imaging) reduce MACE compared to coronary angiography in patients considered for PCI?

P
Population
16,333 participants with >30% coronary stenoses considered for PCI (median 49.3% acute coronary syndrome) from 15 trials, followed for a mean of 34 months.
I
Intervention
Quantitative flow ratio (QFR), fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), or intravascular imaging to guide the decision to perform percutaneous coronary intervention (PCI).
C
Comparator
Coronary angiography (CA) or other physiological/imaging methods.
O
Outcome
Major adverse cardiovascular events (MACE)composite

Main Result

Relative Risk: 0.68 (95% CI 0.56–0.82)

In a network meta-analysis, guiding PCI decisions with quantitative flow ratio (QFR) was associated with a lower risk of MACE compared to coronary angiography, FFR, and iFR.

Limitations

  • Findings are hypothesis-generating and should be validated in large, randomized, head-to-head trials.
  • Findings are hypothesis-generating and require validation in large, randomized, head-to-head trials

Cite This Study

d’Entremont et al. (2024) conducted a meta-analysis in Coronary stenoses (n=16,333). Quantitative flow ratio (QFR) vs. Coronary angiography (CA), fractional flow reserve (FFR), and instantaneous wave-free ratio (iFR) was evaluated on Major adverse cardiovascular events (MACE) (RR 0.68, 95% CI 0.56 to 0.82). Quantitative flow ratio (QFR) to guide PCI decisions was associated with a decreased risk of MACE compared with coronary angiography (RR 0.68; 95% CI 0.56-0.82).

synapsesocial.com/papers/6a7d9668c108c8d3ff044f78https://doi.org/10.1016/j.amjcard.2024.05.019
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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  2. 2Instantaneous wave free ratio vs. fractional flow reserve and 5-year mortality: iFR SWEDEHEART and DEFINE FLAIR2023 · 54 citations
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  4. 4Side effects and major adverse cardiac events caused by fractional flow reserve measurement: a systematic review and meta-analysis of 12,215 patients2022 · 7 citations
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