Comparison among various physiology and angiography-guided strategies for deferring percutaneous coronary intervention: A network meta-analysis

It is unclear whether coronary physiology or coronary angiography (CA)-guided strategy is the more preferable approach for deferring percutaneous coronary intervention (PCI). We sought to evaluate the clinical efficacy of various PCI strategies through a network meta-analysis of randomized controlle...

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Published in:Cardiovascular revascularization medicine 2024-04, Vol.61, p.35-41
Main Authors: Kiyohara, Yuko, Kishino, Yoshikazu, Ueyama, Hiroki A., Takahashi, Tatsunori, Kobayashi, Yuhei, Takagi, Hisato, Wiley, Jose, Kuno, Toshiki
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - diagnostic imaging
Acute Coronary Syndrome - etiology
Acute Coronary Syndrome - therapy
Coronary Angiography - adverse effects
Coronary Artery Disease - diagnostic imaging
Coronary Artery Disease - etiology
Coronary Artery Disease - therapy
Fractional flow reserve
Fractional Flow Reserve, Myocardial
Humans
Instantaneous wave-free ratio
Myocardial Infarction - etiology
Network Meta-Analysis
Percutaneous Coronary Intervention - adverse effects
Quantitative flow ratio
Thrombosis - etiology
Treatment Outcome
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Summary:It is unclear whether coronary physiology or coronary angiography (CA)-guided strategy is the more preferable approach for deferring percutaneous coronary intervention (PCI). We sought to evaluate the clinical efficacy of various PCI strategies through a network meta-analysis of randomized controlled trials (RCTs). We searched multiple databases for RCTs investigating the impact of the following strategies for the purpose of determining whether or not to defer PCI: fractional flow reserve, instantaneous wave-free ratio, quantitative flow ratio (QFR), and CA. We conducted a network meta-analysis for trial-defined major adverse cardiovascular events (MACE), all-cause death, cardiovascular death, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis. We performed a subgroup analysis for those with acute coronary syndrome (ACS). Our search identified 12 eligible RCTs including a total of 13,177 patients. QFR-guided PCI was associated with reduced MACE, MI, and TLR compared with CA-guided PCI (relative risk (RR) 0.68; 95 % confidence interval (CI] [0.49 to 0.94], RR 0.58; 95 % CI [0.36 to 0.96], and RR 0.58; 95 % CI [0.38 to 0.91], respectively). There were no significant differences in any pairs for all-cause death, cardiovascular death, or stent thrombosis. QFR was ranked the best in most outcomes. In the subgroup analysis of the ACS cohort, there were no significant differences in MACE between any comparisons. QFR was associated with reduced MACE, MI, and TLR compared with CA, and ranked the best in most outcomes. However, this was not applied in the ACS cohort. •QFR was associated with reduced MACE, MI, and TLR compared with CA.•QFR was ranked the best in most outcomes among physiology-guided strategies.•The superiority of QFR was not observed in the ACS cohort.
ISSN:1553-8389
1878-0938
DOI:10.1016/j.carrev.2023.10.015