Current problems in cardiology · 2026
Comparing the Clinical Outcomes of Fractional Flow Reserve and Intravascular Imaging in Guiding Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis.
СтатьяОбзорНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Kaushik Sharanya, Balakrishna Akshay Machanahalli, Arvind Shreya, Mangalesh Sridhar, Kumar Sriram Sunil, Torrado Juan, Alam Usman, Gashi Eleonora
Аннотация
BACKGROUND: Fractional flow reserve (FFR) and intravascular imaging (IVI) are both used to guide management of intermediate coronary stenoses, but comparative outcome data remain limited.
METHODS: We systematically searched MEDLINE/PubMed and the Cochrane Central Register of Controlled Trials from inception through September 1, 2025, for randomized controlled trials and comparative observational studies directly comparing physiology-guided versus intravascular imaging-guided strategies for angiographically intermediate coronary stenoses. Outcomes included major adverse cardiovascular events (MACE), all-cause mortality, cardiac mortality, myocardial infarction (MI), target-vessel revascularization (TVR), and PCI rate. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Risk of bias was assessed with RoB 2 for randomized trials and ROBINS-I for observational studies. A sensitivity analysis excluded FLAVOUR II because it used angiography-derived rather than pressure-wire FFR.
RESULTS: Six comparative studies including 5,047 participants were included: four randomized trials and two observational studies. No statistically significant differences were detected in all-cause mortality (RR 0.87, 95% CI 0.53-1.42; p=0.58), cardiac mortality (RR 1.11, 95% CI 0.63-1.96; p=0.72), MACE (RR 1.09, 95% CI 0.88-1.35; p=0.42), nonfatal MI (RR 1.45, 95% CI 0.80-2.64; p=0.22), or TVR (RR 1.27, 95% CI 0.85-1.90; p=0.24). Physiology guidance was associated with lower PCI utilization (RR 0.60, 95% CI 0.48-0.75; p<0.001), with substantial heterogeneity (I²=93.6%). Exclusion of FLAVOUR II did not materially alter the findings, including PCI utilization (RR 0.55, 95% CI 0.45-0.67; I²=76.7%).
CONCLUSIONS: Among patients with intermediate coronary stenoses, FFR- and IVI-guided strategies were associated with similar clinical outcomes, while FFR guidance reduced PCI utilization.
METHODS: We systematically searched MEDLINE/PubMed and the Cochrane Central Register of Controlled Trials from inception through September 1, 2025, for randomized controlled trials and comparative observational studies directly comparing physiology-guided versus intravascular imaging-guided strategies for angiographically intermediate coronary stenoses. Outcomes included major adverse cardiovascular events (MACE), all-cause mortality, cardiac mortality, myocardial infarction (MI), target-vessel revascularization (TVR), and PCI rate. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Risk of bias was assessed with RoB 2 for randomized trials and ROBINS-I for observational studies. A sensitivity analysis excluded FLAVOUR II because it used angiography-derived rather than pressure-wire FFR.
RESULTS: Six comparative studies including 5,047 participants were included: four randomized trials and two observational studies. No statistically significant differences were detected in all-cause mortality (RR 0.87, 95% CI 0.53-1.42; p=0.58), cardiac mortality (RR 1.11, 95% CI 0.63-1.96; p=0.72), MACE (RR 1.09, 95% CI 0.88-1.35; p=0.42), nonfatal MI (RR 1.45, 95% CI 0.80-2.64; p=0.22), or TVR (RR 1.27, 95% CI 0.85-1.90; p=0.24). Physiology guidance was associated with lower PCI utilization (RR 0.60, 95% CI 0.48-0.75; p<0.001), with substantial heterogeneity (I²=93.6%). Exclusion of FLAVOUR II did not materially alter the findings, including PCI utilization (RR 0.55, 95% CI 0.45-0.67; I²=76.7%).
CONCLUSIONS: Among patients with intermediate coronary stenoses, FFR- and IVI-guided strategies were associated with similar clinical outcomes, while FFR guidance reduced PCI utilization.