Meta-analysis of fractional flow reserve versus quantitative coronary angiography and noninvasive imaging for evaluation of myocardial ischemia
Meta-analysis of fractional flow reserve versus quantitative coronary angiography and noninvasive imaging for evaluation of myocardial ischemia
复制标题
DOI：
10.1016/j.amjcard.2006.09.092
复制
发表时间：
2007-02-15
影响因子：
2.8
通讯作者：
Ioannidis, John P. A.
中科院分区：
文献类型：
--
作者：
Christou, Maria A. C.;Siontis, George C. M.;Ioannidis, John P. A.
我们对31项研究进行了荟萃分析，比较了血流储备分数（FFR）与定量冠状动脉造影（QCA）和/或相同病变的无创成像的结果。从PubMed检索研究（最后一次检索2006年2月）。在18项研究（1，522处病变）中，QCA相对于FFR（0.75临界值）的随机效应灵敏度为78%（95%置信区间[CI] 67 - 86），特异性为51%（95% CI 40 - 61）。对于直径狭窄30%至70%的病变，总体一致性为61%，狭窄> 70%为67%，狭窄<30%为95%。与无创成像（21项研究，1，249处病变）相比，FFR的灵敏度为76%（95% CI 69 - 82），随机效应的特异性为76%（95% CI 71 - 81）。受试者-操作者特征估计值总结相似。大多数数据与灌注超声心动图进行了比较（976处病变，灵敏度75%，特异性77%），一些数据也可用于多巴酚丁胺负荷超声心动图（273处病变，灵敏度82%，特异性74%）。总之，QCA不能预测冠状动脉病变的功能意义。血流储备分数显示与无创成像测试的适度一致性。FFR和成像结果不一致的预后意义需要进一步研究。(c)2007爱思唯尔公司All rights reserved.
We performed a meta-analysis of 31 studies comparing the results of fractional flow reserve (FFR) against quantitative coronary angiography (QCA) and/or noninvasive imaging of the same lesions. Studies were retrieved from PubMed (last search February 2006). Across 18 studies (1,522 lesions), QCA had a random effects sensitivity of 78% (95% confidence interval [CI] 67 to 86) and specificity of 51% (95% CI 40 to 61) against FFR (0.75 cutoff). Overall concordances were 61% for lesions with diameter stenosis 30% to 70%, 67% for stenoses > 70%, and 95% for stenoses < 30%. Compared with noninvasive imaging (21 studies, 1,249 lesions), FFR had a sensitivity of 76% (95% Cl 69 to 82) and specificity of 76% (95% CI 71 to 81) by random effects. Summary receiver-operator characteristic estimates were similar. Most data addressed comparisons with perfusion scintigraphy (976 lesions, sensitivity 75%, specificity 77%), and some data were also available for dobutamine stress echocardiography (273 lesions, sensitivity 82%, specificity 74%). In conclusion, QCA does not predict the functional significance of coronary lesions. FFR shows modest concordance with noninvasive imaging tests. The prognostic implications of discordant FFR and imaging results need further study. (c) 2007 Elsevier Inc. All rights reserved.