Impact of impaired fractional flow reserve after coronary interventions on outcomes: a systematic review and meta-analysis

BACKGROUND: FFR is routinely used to guide percutaneous coronary interventions (PCI). Visual assessment of the angiographic result after PCI has limited efficacy. Even when the angiographic result seems satisfactory FFR after a PCI might be useful for identifying patients with a suboptimal interventional result and higher risk for poor clinical outcome who might benefit from additional procedures. The aim of this meta-analysis was to investigate available data of studies that examined clinical outcomes of patients with impaired vs. satisfactory fractional flow reserve (FFR) after percutaneous coronary interventions (PCI). METHODS: This meta-analysis was carried out according to the Cochrane Handbook for Systematic Reviews. The Mantel-Haenszel method using the fixed-effect meta-analysis model was used for combining the results. Studies were identified by searching the literature through mid-January, 2016, using the following search terms: fractional flow reserve, coronary circulation, after, percutaneous coronary intervention, balloon angioplasty, stent implantation, and stenting. Primary endpoint was the rate of major adverse cardiac events (MACE). Secondary endpoints included rates of death, myocardial infarction (MI), repeated revascularisation. RESULTS: Eight relevant studies were found including a total of 1337 patients. Of those, 492 (36.8 %) had an impaired FFR after PCI, and 853 (63.2 %) had a satisfactory FFR after PCI. Odds ratios indicated that a low FFR following PCI was associated with an impaired outcome: major adverse cardiac events (MACE, OR: 4.95, 95 % confidence interval [CI]: 3.39–7.22, p <0.001); death (OR: 3.23, 95 % CI: 1.19–8.76, p = 0.022); myocardial infarction (OR: 13.83, 95 % CI: 4.75–40.24, p <0.0001) and repeated revascularisation (OR: 4.42, 95 % CI: 2.73–7.15, p <0.0001). CONCLUSIONS: Compared to a satisfactory FFR, a persistently low FFR following PCI is associated with a worse clinical outcome. Prospective studies are needed to identify underlying causes, determine an optimal threshold for post-PCI FFR, and clarify whether simple additional procedures can influence the post-PCI FFR and clinical outcome. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12872-016-0355-7) contains supplementary material, which is available to authorized users

Troponin positive chest pain with unobstructed coronary arteries: definitive differential diagnosis using cardiac MRI

Objective: The purpose of this study was to assess the outcome of cardiac MRI (CMRI)with late gadolinium enhancement (LGE) at outpatient follow-up in a consecutiveseries of patients with troponin-positive chest pain but unobstructed coronary arteries at the index admission.Methods: The study comprised 91 consecutive patients who presented to our institution with cardiac chest pain, elevated troponin I and unobstructed coronaryarteries on coronary angiography. All patients underwent an outpatient CMRI with LGE imaging in order to establish a definitive diagnosis.Results: The average time from coronary angiography to LGE-CMRI was 2 months.73% of patients had no abnormality on their LGE-CMRI, 16% of patients had patchy late enhancement consistent with myocarditis and 11% had focal subendocardial or full thickness late enhancement consistent with myocardial infarction. There were nodeaths in this cohort during a mean follow-up of 21 months.Conclusion: LGE-CMRI is a useful tool for establishing whether such patients have definitive evidence of non-ST-segment elevation myocardial infarction (NSTEMI), andcan make an important contribution to the long-term management strategy of these patients as an inappropriate diagnosis of NSTEMI carries important medical, social andfinancial implications

High-dose n-3 fatty acid treatment in non-alcoholic fatty liver disease is independently associated with reduced hepatic steatosis and improved hepatic insulin sensitivity

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