Influence of fractional flow reserve on grafts patency: Systematic review and patient-level meta-analysis

Catheter Cardiovasc Interv. 2022 Feb;99(3):730-735. doi: 10.1002/ccd.29864. Epub 2021 Jul 7.

Abstract

Objective: To investigate the impact of invasive functional guidance for coronary artery bypass graft surgery (CABG) on graft failure.

Background: Data on the impact of fractional flow reserve (FFR) in guiding CABG are still limited.

Methods: Systematic review and individual patient data meta-analysis were performed. Primary objective was the risk of graft failure, stratified by FFR. Risk estimates are reported as odds ratios (ORs) derived from the aggregated data using random-effects models. Individual patient data were analyzed using mixed effect model to assess relationship between FFR and graft failure. This meta-analysis is registered in PROSPERO (CRD42020180444).

Results: Four prospective studies comprising 503 patients referred for CABG, with 1471 coronaries, assessed by FFR were included. Graft status was available for 1039 conduits at median of 12.0 [IQR 6.6; 12.0] months. Risk of graft failure was higher in vessels with preserved FFR (OR 5.74, 95% CI 1.71-19.29). Every 0.10 FFR units decrease in the coronaries was associated with 56% risk reduction of graft failure (OR 0.44, 95% CI 0.34 to 0.59). FFR cut-off to predict graft failure was 0.79.

Conclusion: Surgical grafting of coronaries with functionally nonsignificant stenoses was associated with higher risk of graft failure.

Keywords: coronary artery bypass surgery; fractional flow reserve; graft patency.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Coronary Angiography
  • Coronary Artery Disease* / surgery
  • Coronary Stenosis* / diagnostic imaging
  • Coronary Stenosis* / surgery
  • Fractional Flow Reserve, Myocardial*
  • Humans
  • Prospective Studies
  • Treatment Outcome