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

• Published in: Catheterization and cardiovascular interventions Vol. 99; no. 3; pp. 730 - 735
• Main Authors: G. Toth, Gabor, Collet, Carlos, Langhoff Thuesen, Anne, Mizukami, Takuya, Casselman, Filip, Riber, Lars Peter, Van Praet, Frank, Junker, Anders, Nagumo, Sakura, De Bruyne, Bernard, Okkels Jensen, Lisette, Barbato, Emanuele
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.02.2022; Wiley Subscription Services, Inc
• Subjects: Coronary Angiography; Coronary artery; coronary artery bypass surgery; Coronary Artery Disease - surgery; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - surgery; fractional flow reserve; Fractional Flow Reserve, Myocardial; graft patency; Graft rejection; Grafts; Heart surgery; Humans; Meta-analysis; Patients; Prospective Studies; Systematic review; Treatment Outcome; coronary artery bypass surgery; fractional flow reserve; graft patency
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.29864

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.