Angiography-derived versus wire-based fractional flow reserve for guiding coronary revascularization: a meta-analysis of randomized controlled trials
- 1Department of Cardiology, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital (The Second Clinical College of North Sichuan Medical College)
- 2The Second Clinical College of North Sichuan Medical College
Abstract
Background: Invasive pressure-wire-based fractional flow reserve (FFR) is the reference standard for physiology-guided coronary revascularization, yet it requires pressure-wire equipment and adenosine-induced hyperemia. Angiography-derived FFR enables functional assessment solely from coronary angiograms, while quantitative pooled evidence from patient-level randomized controlled trials (RCTs) remains limited.
Methods: We searched PubMed, Cochrane Library, Embase and Web of Science Core Collection for eligible RCTs comparing angiography-derived FFR-guided versus wire-based FFR-guided revascularization. The primary endpoint was major adverse cardiovascular events (MACE). Pooled risk ratios or mean differences with 95% confidence intervals were calculated. GRADE assessment and trial sequential analysis (TSA) were performed, and publication bias was evaluated by funnel-plot inspection.
Results: Four RCTs involving 6,542 participants were included. No significant difference in MACE was observed between groups (RR 1.07, 95%CI 0.91-1.27). All-cause mortality, cardiac mortality, recurrent myocardial infarction, unplanned revascularization and stent thrombosis were also comparable. Angiography-derived FFR was associated with higher patients-level PCI rate (RR 1.24, 95%CI 1.15-1.33), lesion-level PCI rate (RR 1.24, 95%CI 1.18-1.31) and shorter procedural time (MD −4.09 min, 95%CI −5.76 to −2.43). TSA showed insufficient sample size for most hard clinical endpoints. GRADE certainty varied across endpoints, procedural outcomes were rated high-certainty, while most clinical outcomes were of moderate certainty and stent thrombosis of low certainty.
Conclusions: Relative to wire-based FFR, angiography-derived FFR showed no statistically significant difference in ischaemic-driven clinical outcomes and procedural duration. However, it may increase the likelihood of undergoing PCI. Further large-scale trials with extended follow-up are needed to clarify the long-term implications of this revascularization pattern.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/ , CRD420261479620.
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BibTeX
@article{zhong2026angiographyderived,
title = {{Angiography-derived versus wire-based fractional flow reserve for guiding coronary revascularization: a meta-analysis of randomized controlled trials}},
author = {Peng-Yu Zhong and Qing-Yi Yang and Liu Lei and Lin He and Wei Ni},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1969354},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1969354/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Angiography-derived versus wire-based fractional flow reserve for guiding coronary revascularization: a meta-analysis of randomized controlled trials
AU - Peng-Yu Zhong
AU - Qing-Yi Yang
AU - Liu Lei
AU - Lin He
AU - Wei Ni
PY - 2026
DA - 2026/10/30
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1969354
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1969354/full
AB - Background: Invasive pressure-wire-based fractional flow reserve (FFR) is the reference standard for physiology-guided coronary revascularization, yet it requires pressure-wire equipment and adenosine-induced hyperemia. Angiography-derived FFR enables functional assessment solely from coronary angiograms, while quantitative pooled evidence from patient-level randomized controlled trials (RCTs) remains limited. Methods: We searched PubMed, Cochrane Library, Embase and Web of Science Core Collection for eligible RCTs comparing angiography-derived FFR-guided versus wire-based FFR-guided revascularization. The primary endpoint was major adverse cardiovascular events (MACE). Pooled risk ratios or mean differences with 95% confidence intervals were calculated. GRADE assessment and trial sequential analysis (TSA) were performed, and publication bias was evaluated by funnel-plot inspection. Results: Four RCTs involving 6,542 participants were included. No significant difference in MACE was observed between groups (RR 1.07, 95%CI 0.91-1.27). All-cause mortality, cardiac mortality, recurrent myocardial infarction, unplanned revascularization and stent thrombosis were also comparable. Angiography-derived FFR was associated with higher patients-level PCI rate (RR 1.24, 95%CI 1.15-1.33), lesion-level PCI rate (RR 1.24, 95%CI 1.18-1.31) and shorter procedural time (MD −4.09 min, 95%CI −5.76 to −2.43). TSA showed insufficient sample size for most hard clinical endpoints. GRADE certainty varied across endpoints, procedural outcomes were rated high-certainty, while most clinical outcomes were of moderate certainty and stent thrombosis of low certainty. Conclusions: Relative to wire-based FFR, angiography-derived FFR showed no statistically significant difference in ischaemic-driven clinical outcomes and procedural duration. However, it may increase the likelihood of undergoing PCI. Further large-scale trials with extended follow-up are needed to clarify the long-term implications of this revascularization pattern. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/ , CRD420261479620.
SN - 2297-055X
ER -