FFR-guided versus coronary angiogram-guided CABG: A review and meta-analysis of prospective randomized controlled trials.

Background: Fractional flow reserve (FFR) is a well-established method for the evaluation of coronary artery stenosis before percutaneous coronary intervention. However, whether FFR assessment should be routinely used before coronary artery bypass graft surgery (CABG) remains unclear. A meta-analysis of prospectively randomized controlled trials (PRCTs) was carried out to compare the outcomes of FFR-guided CABG vs coronary angiography (CAG)-guided CABG.

Method: The meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two PRCTs (the FARGO and GRAFFITI trials) were found and included reporting data on 269 patients with 6 and 12 month follow-up. Primary endpoints were rates of overall death, MACCE, target vessel revascularization, and spontaneous myocardial infarction (MI). Secondary endpoints were overall graft patency and patency of arterial and venous grafts.

Results: There were no significant differences between the FFR-guided and CAG-guided groups in the rates of overall death, MACCE, target vessel revascularization, spontaneous MI and graft patency. Meta-analysis of FARGO and GRAFFITI PRCTs showed that FFR-guided CABG and CAG-guided CABG produced similar clinical outcomes with similar graft patency rates up to a year postoperatively.

Conclusion: Currently available PRCTs showes no sufficient evidence to support the use FFR in CABG.