Abstract

Objective Percutaneous coronary intervention (PCI) is increasingly guided by advanced techniques beyond angiography alone.1Fractional Flow Reserve (FFR) and Intravascular Ultrasound (IVUS) are two widely used modalities that offer physiological and anatomical guidance, respectively.2 This study aims to provide an updated evidence-based comparison of FFR versus IVUS in guiding PCI.

Methods A systematic review and meta-analysis were conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic search was performed to identify studies comparing FFR-guided PCI with IVUS-guided PCI. Primary outcomes included major adverse cardiovascular events (MACE), all-cause mortality, cardiac death, non-fatal myocardial infarction (MI), and target vessel revascularisation (TVR). Secondary outcomes were the number of PCI procedures performed. Fixed- or random-effects modelling was used based on heterogeneity.

Results 6 studies with a total of 5040 patients were included, with 2517 in the FFR-guided PCI group and 2523 in the IVUS group. No statistically significant differences were observed between FFR and IVUS in terms of major adverse cardiovascular events (OR = 1.11, 95% CI: 0.89–1.38, P = 0.35; I2 = 15%), all-cause mortality (OR = 0.82, 95% CI: 0.50–1.36, P = 0.45; I2 = 10%), cardiac- related deaths (OR = 1.05, 95% CI: 0.60–1.84, P = 0.87; I2 = 0%), non-fatal myocardial infarction (OR = 1.49, 95% CI: 0.79–2.71, P = 0.22; I2 = 0%), or target vessel revascularisation (OR = 1.20, 95% CI: 0.80–1.79, P = 0.38; I2 = 0%). A significantly higher number of PCI procedures was observed in the IVUS group (OR = 0.56, 95% CI: 0.36–0.88, P = 0.01), although this outcome showed high heterogeneity (I2 = 90%).

Conclusion Both FFR and IVUS are effective strategies for guiding PCI. However, IVUS was associated with a significantly higher rate of PCI procedures, potentially reflecting its sensitivity in lesion detection.