Author + information
- Rahman Shah1,
- Oluwaseun Akinseye2,
- Samuel Latham3,
- Salem Salem4,
- Abdul Rashid5,
- Raza Askari2 and
- Muhammad Shahreyar Shahreyar6
- 1University of Tennessee, Memphis, Tennessee, United States
- 2University of Tennessee Health Science Center, Memphis, Tennessee, United States
- 3UTHSC, Germantown, Tennessee, United States
- 4University of Tennessee, Memphis, United States
- 5University of Tennessee, Jackson, Tennessee, United States
- 6UT, Memphis, Tennessee, United States
In the last decade, fractional flow reserve (FFR) has been gold standard method to asses functional significant of coronary stenosis with intermediate severity. Recently Instantaneous Wave-Free ratio (iFR) has emerged a novel method to assess coronary lesions for functional significance. Therefore, we performed a meta-analysis of RCT comparing efficacy and safety of iFR with FFR for functional assessment of intermediate severity coronary stenosis.
Two reviewers independently extracted the data. Relevant RCTs were included and all analyses were done using random effect models. For continuous outcomes standardized mean difference (SMD), and for dichotomous variables risk ratio (RR) were calculated. The primary efficacy endpoint was MACE (major adverse cardiac events) rate defined as the composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization within 12 months after the procedure. Secondary efficiency endpoints were all-cause mortality, cardiovascular (CV) mortality and un-planned revascularization. Safety endpoint was procedure related adverse symptoms.
We included data involving 4529 patients. iFR-guided revascularization was associated with decrease rate of revascularization (RR ;0.91, 95% CI,0.86-0.96: P = 0.002), and few stents used per patient (SMD = -0.095, 95% CI: -0.029 to -2.799, p =0.005) during the index procedure. Similarly ,iFR was associated with 94% decrease risk of procedure related adverse symptoms (RR ;0.06, 95% CI,0.02-0.15: P <0.001). However, at 1 year follow up, there was no difference in rates of MACE (RR ;1.07, 95% CI,0.81-1.27: P =0.882), all-cause mortality (RR;1.48, 95% CI,0.89-2.45: P = 0.127), CV mortality (RR; 1.50, 95% CI, 0.67-3.37: P = 0.320), and urgent revascularization (RR ;0.85 95% CI,0.62-1.18: P =0.356)between the two strategies.
Among patients with stable angina or an acute coronary syndrome, an iFR-guided revascularization was associated with decrease rate of revascularization, fewer stents per patient and lower procedure related symptoms during the index procedure, but similar rate of MACE and mortality at one year follow up.
IMAGING: FFR and Physiologic Lesion Assessment