Long-Term Clinical Outcome After Fractional Flow Reserve–Guided Percutaneous Coronary Revascularization in Patients With Small-Vessel Disease

Abstract

Background-Small coronary vessels supply small myocardial territories. The clinical significance of small-vessel stenoses is therefore questionable. Moreover, percutaneous coronary intervention (PCI) of nonfunctionally significant lesions does not improve clinical outcome and might be associated with potential procedural or stent related risks.

Comparing treatment outcomes of fractional flow reserve-guided and angiography-guided percutaneous coronary intervention in patients with multi-vessel coronary artery diseases: a systematic review and meta-analysis

“…The number of included studies was relatively small, and three of the seven studies were retrospective. While the results of analysis of retrospective and prospective studies were generally consistent, in some analyses the sensitivity analysis indicated that the results may have been overly influenced by the studies of Li et al [18] and/or Puymirat et al [8]. In addition, only one study used a visual assessment of coronary stenosis, as opposed to quantitative assessment [18].…”

“…Sensitivity analysis indicated the removal of the study by Li et al, [18] and Puymirat et al, [8] resulted in the pooled HR/RR becoming significant ( Figure 5B), indicating that the pooled estimates might be influenced by these two individual studies.…”

“…After reviewing the full texts of the remaining 26 articles, 19 were excluded and the reasons for exclusion are shown in Figure 1A. A total of seven articles were included in the meta-analysis [8,11,[15][16][17][18][19]. Abbreviations: RCT = randomized controlled trials; CAD = coronary artery diseases; PCI = percutaneous coronary intervention; FFR = fractional flow reserve; and, Angio = angiography.…”

“…Together with coronary flow reserve, FFR can provide information about the epicardial artery and the microvascular bed it subtends [7]. FFR-guided percutaneous coronary intervention (PCI) has been shown effective even in small coronary artery stenosis [8]. Furthermore, it has been proven to be cost-saving [6,9,10].…”

Fractional Flow Reserve–Guided PCI versus Medical Therapy in Stable Coronary Disease

“…11- 14 The usefulness of FFR-guided PCI as compared with PCI guided by angiography alone is supported by robust clinical outcome data. 9,10,14- 17 The aim of this trial was to determine whether FFR-guided PCI with drug-eluting stents plus the best available medical therapy is superior to the best available medical therapy alone in reducing the rate of death, myocardial infarction, or unplanned hospitalization leading to urgent revascularization among patients with stable coronary artery disease.…”