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FFR-Guided Versus Coronary Angiogram Guided CABG: A Systematic Review and Meta-Analysis
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  • Dhayan Timbadia,
  • Ashlynn Ler ,
  • Faizus Sazzad,
  • CHRISTOS ALEXIOU,
  • Theodoros Kofidis
Dhayan Timbadia
National University Singapore Yong Loo Lin School of Medicine
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Ashlynn Ler
National University of Ireland Galway School of Medicine
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Faizus Sazzad
National University Heart Centre
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CHRISTOS ALEXIOU
Interbalkan European Medical Centre
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Theodoros Kofidis
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Peer review status:ACCEPTED

27 Apr 2020Submitted to Journal of Cardiac Surgery
28 Apr 2020Submission Checks Completed
28 Apr 2020Assigned to Editor
28 Apr 2020Reviewer(s) Assigned
29 Apr 2020Review(s) Completed, Editorial Evaluation Pending
29 Apr 2020Editorial Decision: Revise Major
29 May 20201st Revision Received
01 Jun 2020Assigned to Editor
01 Jun 2020Submission Checks Completed
01 Jun 2020Reviewer(s) Assigned
04 Jun 2020Review(s) Completed, Editorial Evaluation Pending
05 Jun 2020Editorial Decision: Revise Major
08 Jul 20202nd Revision Received
09 Jul 2020Submission Checks Completed
09 Jul 2020Assigned to Editor
09 Jul 2020Reviewer(s) Assigned
10 Jul 2020Review(s) Completed, Editorial Evaluation Pending
10 Jul 2020Editorial Decision: Accept

Abstract

Background Fractional flow reserve (FFR) is a well-established method for the evaluation of coronary artery stenosis before PCI. However, whether FFR assessment should be routinely used before CABG remains unclear. Our aim was to compare the outcomes of using FFR with that of conventional CAG (coronary angiography) in guiding CABG. Method This systematic review and meta-analysis was performed according to the PRISMA guidelines. Six studies were included, of which four were double-arm (two prospectively randomised) and two single-arm, reporting data on 1931 patients. A meta-analysis was done for double-arm studies, comparing rates of overall death, MACCE, target vessel revascularisation, spontaneous MI and graft patency. The data of all six studies were entered in a pooled analysis for the endpoints of overall death, spontaneous MI and target vessel revascularisation. Results Meta-analysis demonstrated significantly lower death rates in the FFR-guided than the CAG-guided group (p=0.03) and no significant differences in the rates of MACCE, target vessel revascularisation, spontaneous MI and graft patency. In pooled analysis, FFR-guided group was linked with lower rates of overall death and spontaneous MI. Graft occlusion rate was significantly lower after FFR in one retrospective study, however, this difference was lost in meta-analysis (p=0.24). Conclusion In this meta-analysis, FFR-guided CABG was associated with lower overall death rate and was, at least, non-inferior in the endpoints of MACCE, target vessel revascularisation, spontaneous MI and graft patency than CAG-guided CABG. Further randomized trials are needed to define the role of FFR in guiding CABG surgery.