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Title: Fractional flow reserve-guided strategy in acute coronary syndrome. a systematic review and meta-analysis
Author: Martins, José Luís
Afreixo, Vera
Santos, José
Gonçalves, Lino
Keywords: Acute Coronary Syndrome/physiopathology
Percutaneous Coronary Intervention/methods
Coronary Angiography/ methods
Fractional Flow Reserve Myocardial/physiology
Vascular Resistance
Reproducibility of Results
Issue Date: Oct-2018
Publisher: Sociedade Brasileira de Cardiologia
Abstract: Background: There are limited data on the prognosis of deferral of lesion treatment in patients with acute coronary syndrome (ACS) based on fractional flow reserve (FFR). Objectives: To provide a systematic review of the current evidence on the prognosis of deferred lesions in ACS patients compared with deferred lesions in non-ACS patients, on the basis of FFR. Methods: We searched Medline, EMBASE, and the Cochrane Library for studies published between January 2000 and September 2017 that compared prognosis of deferred revascularization of lesions on the basis of FFR in ACS patients compared with non-ACS patients. We conducted a pooled relative risk meta-analysis of four primary outcomes: mortality, cardiovascular (CV) mortality, myocardial infarction (MI) and target-vessel revascularization (TVR). Results: We identified 7 studies that included a total of 5,107 patients. A pooled meta-analysis showed no significant difference in mortality (relative risk [RR] = 1.44; 95% CI, 0.9–2.4), CV mortality (RR = 1.29; 95% CI = 0.4–4.3) and TVR (RR = 1.46; 95% CI = 0.9–2.3) after deferral of revascularization based on FFR between ACS and non-ACS patients. Such deferral was associated with significant additional risk of MI (RR = 1.83; 95% CI = 1.4–2.4) in ACS patients. Conclusion: The prognostic value of FFR in ACS setting is not as good as in stable patients. The results demonstrate an increased risk of MI but not of mortality, CV mortality, and TVR in ACS patients.
Peer review: yes
DOI: 10.5935/abc.20180170
ISSN: 0066-782X
Appears in Collections:CIDMA - Artigos
PSG - Artigos

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