Abstract 4370607: Clinical Outcomes of Fractional Flow Reserve vs. Intravascular Imaging–Guided Percutaneous Coronary Intervention in Intermediate Coronary Lesions: An Updated Meta-Analysis of 5,445 Patients

Abstract

Background: Managing intermediate coronary lesions (ICL) remains a clinical challenge, as angiography alone may be insufficient to guide optimal revascularization. Both Fractional Flow Reserve (FFR) and intravascular imaging (IVI) have emerged as key modalities for guiding percutaneous coronary intervention (PCI). However, with the emergence of newer trials and variability in previous findings, a comprehensive meta-analysis with a larger sample size is warranted to better delineate the optimal guidance strategy.. Research Question: Does FFR-guided PCI result in better clinical outcomes compared to IVI–guided PCI in patients with ICL ? Methods: We searched PubMed, Embase, Cochrane and clinicaltrials.gov for randomized controlled trials (RCTs) and observational studies (OS). Meta-analysis was conducted in R version 4.4.3 using the “meta” and “metasens” packages. A restricted maximum likelihood random-effects model with Hartung-Knapp adjustment was used to calculate risk ratio (RR) with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 and Chi-squared (X2) statistics, with I2 >50% indicating significant heterogeneity. Results: A total of seven studies (four RCTs and three OS) comprising 5,445 patients with a mean age of 65 years were included in this meta-analysis.. There was no statistically significant difference between FFR and IVI in the risk of major adverse cardiovascular events (MACE) (RR: 1.04; 95% CI: 0.86-1.29), all-cause death (RR: 0.95; 95% CI: 0.64-1.41), cardiovascular death (RR: 1.05; 95% CI: 0.59-1.87), myocardial infarction (RR: 1.52; 95% CI: 0.86-2.70), and target vessel revascularization (RR: 1.09; 95% CI: 0.76-1.55). However, FFR was significantly associated with a lower PCI rate as compared to IVI (RR: 0.60; 95% CI: 0.46-0.78). Sensitivity analysis was performed for PCI procedures to address high heterogeneity, omitting Nam et al. 2010 reduced heterogeneity from 86.6% to 81.1%, however, results remain consistent favouring FFR (RR: 0.67; 95% CI: 0.53-0.85). Conclusion: In patients with ICL, FFR–guided PCI demonstrated comparable clinical outcomes to IVI–guided PCI in terms of MACE, mortality, myocardial infarction, and revascularization. Notably, FFR was associated with significantly fewer PCI procedures, underscoring its potential to reduce procedural burden without compromising clinical outcomes.