Abstract
BACKGROUND: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are well-established treatments for multivessel coronary artery disease (CAD), a condition where multiple heart arteries are narrowed. A newer approach, fractional flow reserve (FFR)-guided PCI, uses a specialized measurement to select which artery blockages to treat, aiming to enhance patient outcomes. Despite its adoption, the comparative effectiveness of FFR-guided PCI vs CABG remains unclear, particularly regarding key health outcomes such as survival, heart-related complications, and the need for further procedures. AIM: To evaluate the safety and effectiveness of FFR -guided PCI compared to CABG in patients with multivessel CAD. METHODS: This meta-analysis followed standard reporting guidelines and included randomized controlled trials (RCTs) comparing FFR-guided PCI with CABG in patients with multivessel CAD. We searched medical databases, including PubMed, EMBASE, ScienceDirect, and ClinicalTrials.gov, from their start to May 2025. We calculated combined risk ratios (RRs) with 95% confidence intervals (95%CIs) to analyze the data. RESULTS: Three RCTs were analyzed. There was no notable difference in all-cause mortality between FFR-guided PCI and CABG (RR = 1.01, 95%CI: 0.78-1.31, P = 0.93). However, FFR-guided PCI showed higher rates of major adverse cardiac events (MACEs; RR = 1.30, 95%CI: 1.11-1.52, P = 0.001), myocardial infarction (RR = 1.49, 95%CI: 1.11-2.01, P = 0.009), and repeat revascularization (RR = 2.25, 95%CI: 1.78-2.85, P < 0.00001). Stroke rates were comparable between the two treatments (RR = 0.80, 95%CI: 0.54-1.20, P = 0.28). CONCLUSION: FFR-guided PCI and CABG have similar rates of all-cause mortality and stroke in patients with multivessel CAD. However, CABG results in fewer MACEs, myocardial infarctions, and repeat procedures.