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Meta-analysis
Original research article
Fractional flow reserve in acute coronary syndrome: a meta-analysis and systematic review
  1. Kevin P Liou1,2,3,
  2. Sze-Yuan M Ooi2,3,
  3. Stephen P Hoole1 and
  4. Nick E J West1
  1. 1 Department of Interventional Cardiology, Royal Papworth Hospital, Cambridge, UK
  2. 2 Eastern Heart Clinic, Prince of Wales Hospital, Sydney, Australia
  3. 3 Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
  1. Correspondence to Dr Kevin P Liou; K_liou{at}hotmail.com

Abstract

Background The utility of fractional flow reserve (FFR) to guide revascularisation in the management of acute coronary syndrome (ACS) remains unclear.

Objective This study aims to compare the clinical outcomes of patients following FFR-guided revascularisation for either ACS or stable angina (SA) and in particular focuses on the outcome of those with deferred revascularisation after FFR.

Methods A meta-analysis of existing literature was performed. Outcomes including the rate of major adverse cardiovascular events (MACE), recurrent myocardial infarction (MI), mortality and unplanned revascularisation were analysed.

Results A review of 937 records yielded 9 studies comparing 5457 patients, which were included in the analyses. Patients with ACS had a higher rate of recurrent MI (OR 1.81, p=0.02) and a strong trend towards more MACE and all-cause mortality compared with patients with SA when treated by an FFR-guided revascularisation strategy. Deferral of invasive therapy on the basis of FFR led to a higher rate of MACE (17.6% vs 7.3 %; p=0.004), recurrent MI (5.3% vs 1.5%, p=0.001) and target vessel revascularisation (16.4% vs 5.6 %; p=0.02) in patients with ACS, and a strong trend towards a higher cardiovascular mortality at follow-up when compared with patients with SA.

Conclusion The event rate in patients with ACS is much higher than SA despite following an FFR-guided revascularisation strategy. Deferring revascularisation does not appear to be as safe for ACS as it is for SA using contemporary FFR cut-offs validated in SA. Refinement of the therapeutic strategy for patients with ACS with multivessel disease is needed to redress the balance.

  • Fractional flow reserve
  • acute coronary syndrome
  • angiography

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/openhrt-2018-000934

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    Footnotes

    • Contributors KPL and NEJW were responsible for the original idea. KPL contributed to the planning and conduct of the study as well as data analyses and the drafting of this manuscript. SPH, S-YMO and NEJW provided critical review and contributed to the drafting of this manuscript. KPL is responsible for the overall content of this manuscript as the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.