Coronary artery diseaseMeta-Analysis of Fractional Flow Reserve Versus Quantitative Coronary Angiography and Noninvasive Imaging for Evaluation of Myocardial Ischemia
Section snippets
Study eligibility
We considered English-language studies that had performed FFR measurements and quantitative coronary angiographic or/and noninvasive imaging evaluation for the same coronary lesions. We considered all studies in which ≥5 patients had been examined with FFR and ≥1 other eligible method. Studies were considered regardless of the clinical setting (asymptomatic, stable angina, unstable angina, early after myocardial infarction [MI], other) and regardless of whether they addressed native coronary
Selected studies
The search yielded 263 items; 76 reports were retrieved and examined in full text for eligibility. Of those, we excluded 45 (ineligible diagnostic test comparison n = 11, <5 patients n = 1, review n = 2, nonhuman studies n = 1, all patients/no patients with positive results n = 10, duplicate data from same team n = 7, missing information for 2 × 2 table n = 13 [all addressing QCA; 1 also addressed noninvasive imaging against FFR]). Overall, 31 eligible studies were retained for the
Discussion
Our meta-analysis shows that FFR provides largely independent information against QCA. There is extensive lack of concordance between these tests, especially for lesions with 30% to 70% diameter stenosis. Even for lesions with >70% stenosis, FFR may often suggest no functional significance. However, for lesions with <30% stenosis, the FFR result is almost always negative. FFR results often agree with the results of nonimaging studies, but concordance is far from perfect. Independent information
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