Timbadia Dhayan, Ler Ashlynn, Sazzad Faizus, Alexiou Christos, Kofidis Theo
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Cardiac Thoracic and Vascular Surgery, National University Heart Centre, Singapore.
J Card Surg. 2020 Oct;35(10):2785-2793. doi: 10.1111/jocs.14880. Epub 2020 Jul 22.
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.
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.
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.
Currently available PRCTs showes no sufficient evidence to support the use FFR in CABG.
血流储备分数（FFR）是经皮冠状动脉介入治疗前评估冠状动脉狭窄的一种成熟方法。然而，冠状动脉旁路移植术（CABG）前是否应常规使用FFR评估仍不明确。开展了一项前瞻性随机对照试验（PRCT）的荟萃分析，以比较FFR引导下的CABG与冠状动脉造影（CAG）引导下的CABG的结果。
该荟萃分析遵循系统评价和荟萃分析的首选报告项目指南。发现两项PRCT（FARGO和GRAFFITI试验）并纳入，报告了269例患者6个月和12个月随访的数据。主要终点是总死亡、主要不良心血管和脑血管事件（MACCE）、靶血管血运重建和自发性心肌梗死（MI）的发生率。次要终点是总移植物通畅率以及动脉和静脉移植物的通畅率。
FFR引导组和CAG引导组在总死亡、MACCE、靶血管血运重建、自发性MI和移植物通畅率方面无显著差异。FARGO和GRAFFITI PRCT的荟萃分析表明，FFR引导下的CABG和CAG引导下的CABG产生相似的临床结果，术后长达一年的移植物通畅率相似。
目前可用的PRCT没有充分证据支持在CABG中使用FFR。
