Key result
Percutaneous coronary intervention reduced the risk of major adverse cardiac events by 36% compared to optimal medical therapy in patients with coronary artery disease and an FFR ≤ 0.80.
Why the study?
Intracoronary physiology guides revascularization in CAD, but optimal treatment in the physiological grey-zone area remains unclear and debated.
Does physiology-guided percutaneous coronary intervention reduce major adverse cardiac events compared to optimal medical therapy in patients with coronary artery disease across different FFR values?
Meta-Analysis (n=27,451)
Does physiology-guided percutaneous coronary intervention reduce major adverse cardiac events compared to optimal medical therapy in patients with coronary artery disease across different FFR values?
Answers are grounded in this paper and cite their sources.
Physiology-guided PCI significantly reduces MACE in CAD patients with FFR ≤0.80, while optimal medical therapy is superior for lesions with FFR >0.80, supporting current guideline cutoffs.
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. 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.
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Islam et al. (2024) conducted a meta-analysis in Coronary artery disease (n=27,451). Percutaneous coronary intervention (PCI) vs. Optimal medical therapy (OMT) was evaluated on Major adverse cardiac events (MACE) in patients with FFR ≤ 0.80 (RR 0.64, 95% CI 0.45-0.90, p=<0.01). Percutaneous coronary intervention reduced the risk of major adverse cardiac events by 36% compared to optimal medical therapy in patients with coronary artery disease and an FFR ≤ 0.80.
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