Comparison of Coronary Angiographic-Derived and Intracoronary Imaging-Based Fractional Flow Reserve in Assessing Coronary Artery Stenosis Severity: A Systematic Review and Network Meta-Analysis.

Objective: This systematic review and network meta-analysis aimed to compare the accuracy of coronary angiographic-derived fractional flow reserve (Angio-FFR), optical coherence tomography (OCT)-FFR, and intravascular ultrasound (IVUS)-FFR in evaluating the severity of coronary artery stenosis.

Methods: PubMed, Embase, and Cochrane Library were searched from January 1, 2010 to April 1, 2024 for studies on the accuracy assessment of Angio-FFR, OCT-FFR, and IVUS-FFR. A network meta-analysis was performed with accuracy and analysis of variance models. The diagnostic performance was evaluated through absolute sensitivity (SEN), specificity (SPE), diagnostic dominance index (DDI), and diagnostic odds ratio (DOR), with the corresponding 95% confidence interval (CI).

Results: The analysis included 86 studies (16,552 lesions). Network meta-analysis showed that IVUS-FFR demonstrated the highest absolute SEN of 0.92 (0.91, 0.94), while OCT-FFR demonstrated the highest absolute SPE of 0.92 (0.91, 0.94). In comparison to Angio-FFR, intracoronary imaging (ICI)-FFR demonstrated superior diagnostic performance, with a DDI and DOR of 1.00 (95% CI: 0.99, 1.01) versus 0.96 (95% CI: 0.94, 0.98) and 79.18 (95% CI: 62.20, 92.35) versus 56.15 (95% CI: 52.86, 59.29), respectively. Furthermore, ICI-FFR demonstrated significantly greater overall accuracy than Angio-FFR, with a relative risk of 1.03 (95% CI: 1.01-1.04).

Conclusion: This comprehensive network meta-analysis establishes that ICI-FFR provides superior diagnostic performance for coronary artery stenosis assessment compared to Angio-FFR. These findings support the clinical value of ICI modalities in functional stenosis evaluation.