Abstract：
Evidence regarding the comparative efficacy of the different methods to determine the significance of coronary stenoses in the catheterization laboratory is lacking. We aimed to compare all available methods guiding the decision to perform percutaneous coronary intervention (PCI). We searched Medline, Embase, and CENTRAL until October 5, 2023. We included trials that randomized patients with greater than 30% stenoses who were considered for PCI and reported major adverse cardiovascular events (MACE). We performed a frequentist random-effects network meta-analysis and assessed the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. We included 15 trials with 16,333 participants with a mean weighted follow-up of 34 months. The trials contained a median of 49.3% (interquartile range: 32.6%, 100%) acute coronary syndrome participants. Quantitative flow ratio (QFR) was associated with a decreased risk of MACE compared with coronary angiography (CA) (risk ratio [RR] 0.68, 95% confidence interval [CI] 0.56 to 0.82, high certainty), fractional flow reserve (FFR) (RR 0.73, 95% CI 0.58 to 0.92, moderate certainty), and instantaneous wave-free ratio (iFR) (RR 0.63, 95% CI 0.49 to 0.82, moderate certainty), and ranked first for MACE (88.1% probability of being the best). FFR (RR 0.93, 95% CI 0.82 to 1.06, moderate certainty) and iFR (RR 1.07, 95% CI 0.90 to 1.28, moderate certainty) likely did not decrease the risk of MACE compared with CA. Intravascular imaging may not be associated with a significant decrease in MACE compared with CA (RR 0.85, 95% CI 0.62 to 1.17, low certainty) when used to guide the decision to perform PCI. In conclusion, a decision to perform PCI based on QFR was associated with a decreased risk of MACE compared with CA, FFR, and iFR in a mixed stable coronary disease and acute coronary syndrome population. These hypothesis-generating findings should be validated in large, randomized, head-to-head trials.
摘要：
缺乏有关在导管插入实验室中确定冠状动脉狭窄重要性的不同方式的比较功效的证据。我们旨在比较所有可用的方式来指导进行经皮冠状动脉介入治疗（PCI）的决定。我们搜查了Medline,Embase,和中央至2023年10月5日。我们纳入了随机接受潜在PCI的大于30%狭窄患者并报告了主要不良心血管事件(MACE)的试验。我们进行了频繁随机效应网络荟萃分析，并使用GRADE方法评估了证据的确定性。我们纳入了15项试验，16,333名参与者，平均加权随访34个月。试验的中位数为49.3%(IQR32.6%，100%)急性冠脉综合征(ACS)参与者。与冠状动脉造影（CA）相比，定量流量比（QFR）与MACE风险降低相关（风险比（RR）0.68，95％置信区间（CI）0.56，0.82；高确定性），血流储备分数（FFR）（RR0.73，95CI0.58，0.92；中等确定性），和瞬时无波比（iFR）（RR0.63，95CI0.49，0.82；中等确定性），MACE排名第一(88.1%的概率是最好的)。与CA相比，FFR（RR0.93；95CI0.82，1.06；中度确定性）和iFR（RR1.07，95CI0.90，1.28；中度确定性）可能不会降低MACE的风险。与CA(RR0.85;95CI0.62,1.17;低确定性)相比,血管内成像(IVI)可能与MACE的显著降低无关。总之,与CA相比,基于QFR决定进行PCI与MACE风险降低相关,稳定型冠状动脉疾病和ACS混合人群中的FFR和iFR。这些产生假设的发现应该在很大程度上得到验证，随机化，正面交锋的试验.
