Comparative Outcomes of Fractional Flow Reserve and Intravascular Ultrasound Guidance for Percutaneous Coronary Intervention in Intermediate Lesions: A Systematic Review and Meta‐Analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Objective Advanced techniques beyond angiography increasingly guide percutaneous coronary intervention (PCI). Fractional flow reserve (FFR) and intravascular ultrasound (IVUS) are widely used for physiological and anatomical guidance, respectively. This study compares clinical outcomes of FFR versus IVUS‐guided PCI. Methods We conducted a systematic review and meta‐analysis that identified studies comparing FFR‐ and IVUS‐guided PCI. Primary outcomes included major adverse cardiovascular events (MACE), all‐cause mortality, cardiac death, nonfatal myocardial infarction (MI) and target vessel revascularisation (TVR). A secondary outcome was the number of PCI procedures performed. Random effects modelling was used for all outcomes. Results Six studies comprising 5040 patients (FFR: 2517; IVUS: 2523) were included. There were no significant differences between FFR‐ and IVUS‐guided PCI in the incidence of MACE (RR = 1.13, 95% CI 0.89–1.44), all‐cause mortality (RR = 0.82, 95% CI 0.41–1.64), cardiac death (RR = 1.05, 95% CI 0.60–1.85), nonfatal MI (RR = 1.35, 95% CI 0.72–2.52) or TVR (RR = 1.21, 95% CI 0.81–1.81). Subgroup analyses by study design (observational studies and randomised control trials) showed no significant effect modification for any outcome. There was no significant difference in the number of PCI procedures performed (RR = 0.78, 95% CI 0.59–1.02), although heterogeneity was high ( I 2 = 95 % ). Conclusion FFR and IVUS are both effective for guiding PCI, with similar outcomes in terms of MACE, mortality, MI, TVR and PCI procedures performed. Modality selection should be tailored to lesion complexity, institutional expertise and resource availability.
Source: Cardiovascular Therapeutics
Institutions: Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, University of Oxford, King's College Hospital NHS Foundation Trust, Royal Preston Hospital, Barking, Havering And Redbridge University Hospitals NHS Trust, University of Leicester, Glenfield Hospital, University Hospitals of Leicester NHS Trust
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,160
OpenAlex ID: W7141386363