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Introduction <p>Angiography-derived fractional flow reserve (FFR) has emerged as a wire-free alternative to pressure-wire–based physiological assessment for guiding percutaneous coronary intervention (PCI). However, comparative clinical outcomes and procedural implications remain uncertain.</p> Methods <p>A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted in accordance with PRISMA guidelines. Databases were searched from inception to April 2026. Studies comparing angiography-derived FFR with pressure-wire–based strategies in patients undergoing PCI were included. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Pre-specified subgroup analyses were performed based on technology type and comparator composition.</p> Results <p>Three RCTs were included. Angiography-derived strategies demonstrated no significant difference compared with wire-based approaches for the primary composite outcome (RR: 1.14; 95% CI: 0.85 to 1.55), all-cause mortality, cardiac mortality, myocardial infarction (MI), or revascularization. However, angiography-derived guidance significantly reduced procedural time (MD: − 2.83&#xa0;min; 95% CI: − 4.94 to − 0.72), fluoroscopy time (MD: − 2.50&#xa0;min; 95% CI: − 3.38 to − 1.61), and contrast volume (MD: − 6.99 mL; 95% CI: − 11.57 to − 2.40).</p> Conclusions <p>Angiography-derived physiological assessment provides comparable 1-year clinical outcomes to pressure-wire–based strategies while improving procedural efficiency. However, outcomes may vary by platform, highlighting the importance of technology-specific evaluation in future research.</p>

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Angiography-derived versus pressure-wire–based physiological assessment to guide percutaneous coronary intervention: a systematic review and meta-analysis of randomised controlled trials

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月18日

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  • Mahwish Sarwar,
  • Shaikh Muhammad Daniyal,
  • Shaheer Bin Shafiq,
  • Naveen Murad Khatoon,
  • Amna Noor,
  • Muhammad Tahir,
  • Minahil Riaz,
  • Ayan Khalid,
  • Fizza Batool,
  • Minaam Farooq,
  • Augustine George,
  • Romal Jabarkhil

摘要

Introduction

Angiography-derived fractional flow reserve (FFR) has emerged as a wire-free alternative to pressure-wire–based physiological assessment for guiding percutaneous coronary intervention (PCI). However, comparative clinical outcomes and procedural implications remain uncertain.

Methods

A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted in accordance with PRISMA guidelines. Databases were searched from inception to April 2026. Studies comparing angiography-derived FFR with pressure-wire–based strategies in patients undergoing PCI were included. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Pre-specified subgroup analyses were performed based on technology type and comparator composition.

Results

Three RCTs were included. Angiography-derived strategies demonstrated no significant difference compared with wire-based approaches for the primary composite outcome (RR: 1.14; 95% CI: 0.85 to 1.55), all-cause mortality, cardiac mortality, myocardial infarction (MI), or revascularization. However, angiography-derived guidance significantly reduced procedural time (MD: − 2.83 min; 95% CI: − 4.94 to − 0.72), fluoroscopy time (MD: − 2.50 min; 95% CI: − 3.38 to − 1.61), and contrast volume (MD: − 6.99 mL; 95% CI: − 11.57 to − 2.40).

Conclusions

Angiography-derived physiological assessment provides comparable 1-year clinical outcomes to pressure-wire–based strategies while improving procedural efficiency. However, outcomes may vary by platform, highlighting the importance of technology-specific evaluation in future research.