Comparing the clinical outcomes of fractional flow reserve and intravascular imaging in guiding percutaneous coronary intervention: A systematic review and meta-analysis.
Sharanya Kaushik, Akshay Machanahalli Balakrishna, Shreya Arvind et al.
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In 30 seconds
This systematic review and meta-analysis compared fractional flow reserve (FFR)-guided with intravascular imaging (IVI)-guided management of angiographically intermediate coronary stenoses. It included six comparative studies—four randomised trials and two observational studies—with 5,047 participants. Pooled analyses found no statistically significant differences in mortality, major adverse cardiovascular events, nonfatal myocardial infarction, or target-vessel revascularisation. FFR guidance was associated with lower PCI utilisation than IVI guidance (RR 0.60, 95% CI 0.48-0.75; p < 0.001), although this result had substantial heterogeneity.
Key findings
- FFR guidance was associated with lower PCI utilisation than IVI guidance (RR 0.60, 95% CI 0.48-0.75; p < 0.001; I²=93.6%).
- MACE did not differ significantly between strategies (RR 1.09, 95% CI 0.88-1.35; p = 0.42).
- No statistically significant differences were detected in all-cause mortality, cardiac mortality, nonfatal MI, or target-vessel revascularisation.
- Excluding FLAVOUR II did not materially change the findings; PCI utilisation remained lower with physiology guidance (RR 0.55, 95% CI 0.45-0.67; I²=76.7%).
Why it matters
For intermediate coronary stenoses, the pooled evidence suggests that FFR- and IVI-guided strategies have similar measured clinical outcomes, while FFR guidance is associated with fewer PCIs. This distinction may inform how clinicians interpret the trade-off between procedural use and clinical outcomes, while recognising that the evidence does not establish superiority for major clinical events.
What to keep in mind
The review combined randomised and observational studies, and PCI-utilisation results showed substantial heterogeneity (I²=93.6%).