Cardiovascular Outcomes in Patients With Deferred and Performed Coronary Revascularization Based on Intracoronary Physiology: A Systematic Review and Meta-Analysis.

BACKGROUND

Although large studies and pooled analyses of individual patient data have demonstrated the safety of deferring coronary revascularization based on a nonischemic intracoronary pressure index result, conflicting findings have emerged in specific patient subsets and with varying follow-up. Thus, we conducted an updated comprehensive systematic review and meta-analysis to investigate the cardiovascular outcomes associated with deferred or performed coronary revascularization based on intracoronary physiology.

METHODS

Available studies were identified through a systematic search of PubMed, EMBASE, and CENTRAL. Efficacy outcomes investigated were major adverse cardiovascular events, all-cause death, cardiovascular death, noncardiovascular death, myocardial infarction, and unplanned revascularization.

RESULTS

A total of 24 studies enrolling 24 285 patients were included in the meta-analysis. After a mean±SD follow-up of 2.6±1.6 years, patients undergoing physiology-guided deferred revascularization show consistently better outcomes than patients who underwent revascularization, including all-cause death (incidence rate ratio [IRR], 1.14 [95% CI, 1.00-1.30]; P=0.05), cardiovascular death (IRR, 1.53 [95% CI, 1.17-2.00]; P=0.002), and unplanned revascularization (IRR, 1.38 [95% CI, 1.06-1.79]; P=0.01). For major adverse cardiovascular events (IRR, 1.15 [95% CI, 0.99-1.34]; P=0.07) and myocardial infarction (IRR, 1.24 [95% CI, 0.95-1.61]; P=0.11), the associations did not reach statistical significance.

CONCLUSIONS

Patients in whom revascularization was deferred based on intracoronary physiology show lower risk of adverse cardiovascular events compared with those who underwent revascularization. These findings suggest that pressure wire assessment has prognostic implications besides the indication for revascularization.