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J Chest Surg

Published online November 9, 2022

Copyright © Journal of Chest Surgery.

The Impact of Fractional Flow Reserve on Clinical Outcomes after Coronary Artery Bypass Grafting: A Meta-analysis

Yoonjin Kang, M.D. 1, Heeju Hong, M.D. 1, Suk Ho Sohn, M.D. 1, Myoung-jin Jang, Ph.D. 2,*, Ho Young Hwang, M.D., Ph.D. 1,*

1Department of Thoracic and Cardiovascular Surgery and 2Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

Correspondence to:Ho Young Hwang
Tel 82-2-2072-3020
Fax 82-2-765-7117
E-mail scalpel@snu.ac.kr
ORCID
https://orcid.org/0000-0002-8935-8118

Myoung-jin Jang
Tel 82-2-740-8880
Fax 82-2-765-7117
E-mail mjjang@snuh.org
ORCID
https://orcid.org/0000-0001-8123-5001

*These authors contributed equally to this work as corresponding authors.

Received: July 20, 2022; Revised: August 29, 2022; Accepted: September 7, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: This meta-analysis was conducted to evaluate the effect of fractional flow reserve (FFR) on clinical outcomes after coronary artery bypass grafting (CABG).
Methods: Five online databases were searched for studies that (1) enrolled patients who underwent isolated CABG or CABG with aortic valve replacement and (2) demonstrated the effect of an FFR-guided strategy on major adverse cardiac events (MACE) after surgery based on a randomized controlled trial or adjusted analysis. MACE included cardiac death, acute myocardial infarction (MI), and repeated revascularization. The primary outcomes were all MACE outcomes and a composite of all-cause death and MI, and the secondary outcomes were the individual MACE outcomes. Publication bias was assessed using a funnel plot and the Egger test.
Results: Six articles (3 randomized and 3 non-randomized studies: n=1,027) were selected. MACE data were extracted from 4 studies. The pooled analyses showed that the risk of MACE was not significantly different between patients who underwent FFR-guided CABG and those who underwent angiography-guided CABG (hazard ratio [HR], 0.80; 95% CI, 0.57–1.12). However, the risk of the composite of death or MI was significantly lower in patients undergoing FFR-guided CABG (HR=0.62; 95% CI, 0.41–0.94). The individual MACE outcomes were not significantly different between FFR-guided and angiography-guided CABG.
Conclusion: FFR-guided CABG might be beneficial in terms of the composite outcome of death or MI compared with angiography-guided CABG although data are limited.

Keywords: Fractional flow reserve, Coronary artery bypass grafting, Statistics, Meta-analysis

Article

ahead

J Chest Surg

Published online November 9, 2022

Copyright © Journal of Chest Surgery.

The Impact of Fractional Flow Reserve on Clinical Outcomes after Coronary Artery Bypass Grafting: A Meta-analysis

Yoonjin Kang, M.D. 1, Heeju Hong, M.D. 1, Suk Ho Sohn, M.D. 1, Myoung-jin Jang, Ph.D. 2,*, Ho Young Hwang, M.D., Ph.D. 1,*

1Department of Thoracic and Cardiovascular Surgery and 2Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

Correspondence to:Ho Young Hwang
Tel 82-2-2072-3020
Fax 82-2-765-7117
E-mail scalpel@snu.ac.kr
ORCID
https://orcid.org/0000-0002-8935-8118

Myoung-jin Jang
Tel 82-2-740-8880
Fax 82-2-765-7117
E-mail mjjang@snuh.org
ORCID
https://orcid.org/0000-0001-8123-5001

*These authors contributed equally to this work as corresponding authors.

Received: July 20, 2022; Revised: August 29, 2022; Accepted: September 7, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: This meta-analysis was conducted to evaluate the effect of fractional flow reserve (FFR) on clinical outcomes after coronary artery bypass grafting (CABG).
Methods: Five online databases were searched for studies that (1) enrolled patients who underwent isolated CABG or CABG with aortic valve replacement and (2) demonstrated the effect of an FFR-guided strategy on major adverse cardiac events (MACE) after surgery based on a randomized controlled trial or adjusted analysis. MACE included cardiac death, acute myocardial infarction (MI), and repeated revascularization. The primary outcomes were all MACE outcomes and a composite of all-cause death and MI, and the secondary outcomes were the individual MACE outcomes. Publication bias was assessed using a funnel plot and the Egger test.
Results: Six articles (3 randomized and 3 non-randomized studies: n=1,027) were selected. MACE data were extracted from 4 studies. The pooled analyses showed that the risk of MACE was not significantly different between patients who underwent FFR-guided CABG and those who underwent angiography-guided CABG (hazard ratio [HR], 0.80; 95% CI, 0.57–1.12). However, the risk of the composite of death or MI was significantly lower in patients undergoing FFR-guided CABG (HR=0.62; 95% CI, 0.41–0.94). The individual MACE outcomes were not significantly different between FFR-guided and angiography-guided CABG.
Conclusion: FFR-guided CABG might be beneficial in terms of the composite outcome of death or MI compared with angiography-guided CABG although data are limited.

Keywords: Fractional flow reserve, Coronary artery bypass grafting, Statistics, Meta-analysis

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