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Background <p>At present, the benefits associated with fractional flow reserve (FFR)-guided complete revascularization (CR) for instances of non-culprit stenosis in patients of coronary artery disease (CAD) affected by multivessel disease (MVD) remain poorly understood. This systematic review and meta-analysis was undertaken to clarify the cardiovascular benefits associated with FFR-guided and angiography-guided CR in patients with CAD and MVD.</p> Methods <p>The PubMed, Embase, and Cochrane databases were searched to locate randomized control trials (RCTs) comparing FFR-guided CR with angiography-guided CR or culprit-only percutaneous intervention (PCI). The primary outcome is major adverse cardiovascular events (MACE), as well as secondary outcomes were all-cause mortality, cardiac mortality, recurrent myocardial infarction (MI) incidence. Primary and secondary outcomes were compared among groups using DerSimonian and Laird random-effects models.</p> Results <p>Ten RCTs enrolling 7249 participants were included. No significant differences were found between FFR- and angiography-guided CR use in patients with CAD and MVD in terms of MACE (RR: 0.88, 95%CI: 0.69–1.12, <i>P</i> = 0.302), cardiac mortality (RR: 0.90, 95%CI: 0.45–1.80. <i>P</i> = 1.000), recurrent MI (RR: 0.83, 95%CI: 0.55–1.25, <i>P</i> = 0.376), repeat revascularization (RR: 0.93, 95%CI: 0.71–1.21, <i>P</i> = 0.574), or target lesion revascularization (TLR; RR: 0.90, 95%CI: 0.33–2.48 <i>P</i> = 0.840). All-cause mortality was similar between the groups (RR: 1.00, 95%CI: 0.57–1.75, <i>P</i> = 1.000). Relative to culprit-only PCI, FFR-guided CR was associated with reduced risk of repeat revascularization (RR: 0.50, 95%CI: 0.37–0.68, <i>P</i> &lt; 0.001) and TLR (RR: 0.31, 95%CI: 0.2–0.48, <i>P</i> &lt; 0.001), while MACE incidence did not differ significantly between the two groups (RR: 0.72, 95%CI: 0.51–1.01, <i>P</i> = 0.006), nor did all-cause mortality (RR: 1.09, 95%CI: 0.84–1.42, <i>P</i> = 0.526), cardiac mortality (RR: 0.82, 95%CI: 0.55–1.21, <i>P</i> = 0.312), or recurrent MI (RR: 0.85, 95%CI: 0.73–1.24, <i>P</i> = 0.713).</p> Conclusion <p>FFR-guided CR was found to linked with reduced repeat revascularization and TLR in individuals with CAD and MVD in comparison with culprit-only PCI. While no significant difference was detected between FFR-guided and angiography-guided CR procedures for the analyzed cardiovascular outcomes, a lower absolute number of adverse events was noted with FFR-guided CR. These findings indicate that the FFR-guided CR of non-culprit vessels may help reduce the need for the implantation of stents in patients with CAD and MVD without any adverse impact on their prognostic outcomes.</p>

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Evaluation of the relative benefits of FFR-guided, angiography-guided CR or culprit-only revascularization in patients with multivessel coronary disease: a systematic review and meta-analysis

  • 期刊论文

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  • 发表日期：

    2025年11月26日

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  • Xuan-Yan Liu,
  • Xian-Dan Wu,
  • Yue Lin,
  • Xian Lin,
  • Yan-Yan Li,
  • Bin-Hua Ye,
  • Jing-Chao Sun

摘要

Background

At present, the benefits associated with fractional flow reserve (FFR)-guided complete revascularization (CR) for instances of non-culprit stenosis in patients of coronary artery disease (CAD) affected by multivessel disease (MVD) remain poorly understood. This systematic review and meta-analysis was undertaken to clarify the cardiovascular benefits associated with FFR-guided and angiography-guided CR in patients with CAD and MVD.

Methods

The PubMed, Embase, and Cochrane databases were searched to locate randomized control trials (RCTs) comparing FFR-guided CR with angiography-guided CR or culprit-only percutaneous intervention (PCI). The primary outcome is major adverse cardiovascular events (MACE), as well as secondary outcomes were all-cause mortality, cardiac mortality, recurrent myocardial infarction (MI) incidence. Primary and secondary outcomes were compared among groups using DerSimonian and Laird random-effects models.

Results

Ten RCTs enrolling 7249 participants were included. No significant differences were found between FFR- and angiography-guided CR use in patients with CAD and MVD in terms of MACE (RR: 0.88, 95%CI: 0.69–1.12, P = 0.302), cardiac mortality (RR: 0.90, 95%CI: 0.45–1.80. P = 1.000), recurrent MI (RR: 0.83, 95%CI: 0.55–1.25, P = 0.376), repeat revascularization (RR: 0.93, 95%CI: 0.71–1.21, P = 0.574), or target lesion revascularization (TLR; RR: 0.90, 95%CI: 0.33–2.48 P = 0.840). All-cause mortality was similar between the groups (RR: 1.00, 95%CI: 0.57–1.75, P = 1.000). Relative to culprit-only PCI, FFR-guided CR was associated with reduced risk of repeat revascularization (RR: 0.50, 95%CI: 0.37–0.68, P < 0.001) and TLR (RR: 0.31, 95%CI: 0.2–0.48, P < 0.001), while MACE incidence did not differ significantly between the two groups (RR: 0.72, 95%CI: 0.51–1.01, P = 0.006), nor did all-cause mortality (RR: 1.09, 95%CI: 0.84–1.42, P = 0.526), cardiac mortality (RR: 0.82, 95%CI: 0.55–1.21, P = 0.312), or recurrent MI (RR: 0.85, 95%CI: 0.73–1.24, P = 0.713).

Conclusion

FFR-guided CR was found to linked with reduced repeat revascularization and TLR in individuals with CAD and MVD in comparison with culprit-only PCI. While no significant difference was detected between FFR-guided and angiography-guided CR procedures for the analyzed cardiovascular outcomes, a lower absolute number of adverse events was noted with FFR-guided CR. These findings indicate that the FFR-guided CR of non-culprit vessels may help reduce the need for the implantation of stents in patients with CAD and MVD without any adverse impact on their prognostic outcomes.