P2356Comparison between functional and intravascular imaging approach guiding percutaneous coronary intervention: a network meta-analysis of randomized and propensity matching studies

Abstract

Background: The optimal approach to guide percutaneous coronary intervention (PCI) has to be defined. Aim of this study was to compare functional driven (fractional flow reserve, FFR) vs intravascular imaging (intravascular ultrasound, IVUS, and optical coherence tomography, OCT) or standard (coronary angiography, CA) guided PCI. Purpose(s): The purpose of this study was to analyze whether a functional or an anatomical approach to coronary artery disease could be considered the better. Method(s): Randomized controlled trials (RCTs) and propensity matched studies (PSWMs) comparing different FFR, IVUS or OCT vs angio guided PCI were included. MACE (acomposite end point of death, myocardial infarction (MI) and revascularization) was the primary end point, while definite Stent Thrombosis (ST) and single components of MACE were the secondary ones. Result(s): 34 studies were included in the analysis, 18 RCTs and 16 PSWMs. CA showed to be inferior to IVUS in term of MACE (OR 1.42; 1.14-1.91), death (OR 1.34; 1.03-2.01), TVR (OR 1.49; 1.1-2.36) and ST (OR 1.29; 1,02-1,67). Furthermore, it performed worse in term of death (OR 1.28; 1.02-1.6) and TVR (OR 1.4; 1.04-1.85) compared with FFR, while there was just a trend for MACE (OR 1.24, 0.98-1.55) and no differences in ST. Indeed, OCT performed similar to CA regarding MACE, death, TVR and MI, but showed a trend of for the reduction of ST (OR 13.31; 1.62-67.23). Indirect comparison among FFR, IVUS and OCT did not show significant differences in term of primary or secondary outcome except for a reduction of death for OCT compared with FFR (OR 1.91; 1.03-3.36). Conclusion(s): Functional and intravascular imaging approach seem to perform similar in term of clinical outcomes, while both performed better compared with the standard approach.