Outcomes with Deferred Versus Performed Revascularization of Coronary Lesions with Gray-Zone Fractional Flow Reserve Values

Michael Megaly, Charl Khalil, Marwan Saad, Iosif Xenogiannis, Mohamed Omer, Mahesh Anantha Narayanan, Ashish Pershad, Santiago Garcia, Arnold H. Seto, M. Nicholas Burke, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Management of coronary lesions with fractional flow reserve values in the gray zone (0.75-0.80) remains controversial due to conflicting data on the performance versus deferral of revascularization. Methods: We performed a systematic review and meta-Analysis of 7 observational studies including 2683 patients that compared the outcomes of deferred versus performed revascularization of coronary lesions with gray-zone fractional flow reserve values. Results: During a mean follow-up of 31±9 months, the incidence of major adverse cardiovascular events (12.54 % versus 11.25%; odds ratio [OR], 1.64 [95% CI, 0.78-3.44]; P=0.19, I2=84%), cardiac mortality (1.25% versus 0.72%; OR, 1.78 [95% CI, 0.58-5.46]; P=0.31, I2=18%), and myocardial infarction (1.28% versus 2.66%; OR, 0.79 [95% CI, 0.22-2.79]; P=0.71, I2=65%) was similar with deferral versus performance of revascularization in coronary lesions with gray-zone fractional flow reserve. Deferral of revascularization was associated with a higher incidence of target vessel revascularization (9.12% versus 5.78%; OR, 1.85 [95% CI, 1.03-3.33]; P=0.04, I2=62%). When the analysis was limited only to studies that used percutaneous coronary intervention for revascularization, deferred revascularization remained associated with a higher risk of target vessel revascularization (18% versus 7.3%; OR, 3.04 [95% CI, 1.53-6.02]; P<0.001) and was associated with a higher risk of major adverse cardiovascular event (23.2% versus 13.4%; OR, 3.38 [95% CI, 1.92-5.95]; P<0.001). Conclusions: In lesions with gray-zone fractional flow reserve, revascularization was associated with a similar incidence of major adverse cardiovascular event but a lower incidence of target vessel revascularization over a mean follow-up of approximately 2.5 years. Clinical Trial Registration: URL: https://www.crd.york.ac.uk/prospero/. Unique identifier: CRD42019128076.

Original languageEnglish (US)
Article numbere008315
JournalCirculation: Cardiovascular Interventions
Volume12
Issue number12
DOIs
StatePublished - Dec 1 2019
Externally publishedYes

Keywords

  • fractional flow reserve
  • percutaneous coronary intervention
  • physiological assessment of coronary lesions

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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