Background Fractional flow reserve (FFR) is a well‐established method for the evaluation of coronary artery stenosis before percutaneous coronary intervention. However, whether FFR assessment should be routinely used before coronary artery bypass graft surgery (CABG) remains unclear. A meta‐analysis of prospectively randomized controlled trials (PRCTs) was carried out to compare the outcomes of FFR‐guided CABG vs coronary angiography (CAG)‐guided CABG. Method The meta‐analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Two PRCTs (the FARGO and GRAFFITI trials) were found and included reporting data on 269 patients with 6 and 12 month follow‐up. Primary endpoints were rates of overall death, MACCE, target vessel revascularization, and spontaneous myocardial infarction (MI). Secondary endpoints were overall graft patency and patency of arterial and venous grafts. Results There were no significant differences between the FFR‐guided and CAG‐guided groups in the rates of overall death, MACCE, target vessel revascularization, spontaneous MI and graft patency. Meta‐analysis of FARGO and GRAFFITI PRCTs showed that FFR‐guided CABG and CAG‐guided CABG produced similar clinical outcomes with similar graft patency rates up to a year postoperatively. Conclusion Currently available PRCTs showes no sufficient evidence to support the use FFR in CABG.

Objective The objective of this meta‐analysis is to evaluate the impact of genetic polymorphisms on platinum‐based chemotherapy (PBC)‐induced ototoxicity. Data Sources Systematic searches of PubMed, Embase, Cochrane, and Web of Science were conducted from the inception of the databases to May 31, 2022. Abstracts and presentations from conferences were also reviewed. Review Methods Four investigators independently extracted data in adherence to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Differences in the prevalence of PBC‐induced ototoxicity between reference and variant (i) genotypes and (ii) alleles were analyzed. The overall effect size was presented using the random‐effects model as an odds ratio (OR) with a 95% confidence interval (CI). Results From 32 included articles, 59 single nucleotide polymorphisms on 28 genes were identified, with 4406 total unique participants. For allele frequency analysis, the A allele in ACYP2 rs1872328 was positively associated with ototoxicity (OR: 2.61; 95% CI: 1.06‐6.43; n = 2518). Upon limiting to cisplatin use only, the T allele of COMT rs4646316 and COMT rs9332377 revealed significant results. For genotype frequency analysis, the CT/TT genotype in ERCC2 rs1799793 demonstrated an otoprotective effect (OR: 0.50; 95% CI: 0.27‐0.94; n = 176). Excluding studies using carboplatin or concomitant radiotherapy revealed significant effects with COMT rs4646316, GSTP1 rs1965, and XPC rs2228001. Major sources of variations between studies include differences in patient demographics, ototoxicity grading systems, and treatment protocols. Conclusion Our meta‐analysis presents polymorphisms that exert ototoxic or otoprotective effects in patients undergoing PBC. Importantly, several of these alleles are observed at high frequencies globally, highlighting the potential for polygenic screening and cumulative risk evaluation for personalized care.

Background Fractional flow reserve (FFR) is a well-established method for the evaluation of coronary artery stenosis before PCI. However, whether FFR assessment should be routinely used before CABG remains unclear. Our aim was to compare the outcomes of using FFR with that of conventional CAG (coronary angiography) in guiding CABG. Method This systematic review and meta-analysis was performed according to the PRISMA guidelines. Six studies were included, of which four were double-arm (two prospectively randomised) and two single-arm, reporting data on 1931 patients. A meta-analysis was done for double-arm studies, comparing rates of overall death, MACCE, target vessel revascularisation, spontaneous MI and graft patency. The data of all six studies were entered in a pooled analysis for the endpoints of overall death, spontaneous MI and target vessel revascularisation. Results Meta-analysis demonstrated significantly lower death rates in the FFR-guided than the CAG-guided group (p=0.03) and no significant differences in the rates of MACCE, target vessel revascularisation, spontaneous MI and graft patency. In pooled analysis, FFR-guided group was linked with lower rates of overall death and spontaneous MI. Graft occlusion rate was significantly lower after FFR in one retrospective study, however, this difference was lost in meta-analysis (p=0.24). Conclusion In this meta-analysis, FFR-guided CABG was associated with lower overall death rate and was, at least, non-inferior in the endpoints of MACCE, target vessel revascularisation, spontaneous MI and graft patency than CAG-guided CABG. Further randomized trials are needed to define the role of FFR in guiding CABG surgery. Statistical analysesForest plots for double-arm studies were generated using RevMan 5.3 10 . All meta-analyses were carried out using fixed-effects models and risk ratios were calculated. Pooled data analyses were carried out using OpenMeta[Analyst] software 11 . The outcomes were pooled using random-effect model. Weighed pooled rates were calculated with confidence intervals. Results Study selectionThe systematic search revealed a total of 5843 papers. After duplicates were excluded, 3435 papers remained for review. Based on title and abstract review, irrelevant publications for those that did not satisfy our inclusion criteria were not considered, leaving 9 articles 6,12-19 for full-text review. Following the full-text assessment of these articles, studies that lacked data on outcomes of FFR guided CABG, or which did not meet our inclusion criteria were excluded (Figure 1) leaving a total of 6 articles 12-17 to be analysed.