Am J Cardiol. 2026 Jun 21:S0002-9149(26)00419-4. doi: 10.1016/j.amjcard.2026.06.020. Online ahead of print.
ABSTRACT
Coronary artery bypass grafting (CABG) is traditionally guided by coronary angiography, although angiographic severity may not accurately reflect the physiological significance of coronary lesions. Fractional flow reserve (FFR) improves outcomes in percutaneous coronary intervention, but its role in guiding CABG remains uncertain. We conducted a meta-analysis of randomized controlled trials (RCTs) comparing FFR-guided versus angiography-guided CABG. Electronic databases were systematically searched from inception to April 2026. Outcomes included all-cause death, myocardial infarction (MI), and stroke. Random-effects models were used to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs). Three RCTs including 1,061 patients were analyzed, with 533 patients assigned to FFR-guided CABG. During a mean follow-up of 15 months, FFR-guided CABG was associated with a significantly lower risk of MI compared with angiography-guided CABG (RR 0.48, 95% CI 0.26-0.89; P=0.01; I²=0%). There were no statistically significant differences in all-cause death (RR 0.74, 95% CI 0.52-1.07; P=0.10; I²=0%) or stroke (RR 1.60, 95% CI 0.94-2.74; P=0.08; I²=0%). Risk of bias was low across all included trials. In conclusion, FFR-guided CABG was associated with a reduced incidence of MI compared with angiography-guided CABG, without significant differences in all-cause death or stroke. Larger trials with longer follow-up are needed to further define the role of physiology-guided surgical revascularization.
PMID:42323984 | DOI:10.1016/j.amjcard.2026.06.020