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Cardiovascular Outcomes in Patients With Deferred and Performed Coronary Revascularization Based on Intracoronary Physiology : A Systematic Review and Meta-Analysis

Lombardi, Marco ; Travieso, Alejandro ; Cerrato, Enrico ; Mohammad, Moman A LU orcid ; Götberg, Matthias LU ; Davies, Justin and Escaned, Javier (2026) In Journal of the American Heart Association p.1-13
Abstract

BACKGROUND: Although large studies and pooled analyses of individual patient data have demonstrated the safety of deferring coronary revascularization based on a nonischemic intracoronary pressure index result, conflicting findings have emerged in specific patient subsets and with varying follow-up. Thus, we conducted an updated comprehensive systematic review and meta-analysis to investigate the cardiovascular outcomes associated with deferred or performed coronary revascularization based on intracoronary physiology.

METHODS: Available studies were identified through a systematic search of PubMed, EMBASE, and CENTRAL. Efficacy outcomes investigated were major adverse cardiovascular events, all-cause death, cardiovascular death,... (More)

BACKGROUND: Although large studies and pooled analyses of individual patient data have demonstrated the safety of deferring coronary revascularization based on a nonischemic intracoronary pressure index result, conflicting findings have emerged in specific patient subsets and with varying follow-up. Thus, we conducted an updated comprehensive systematic review and meta-analysis to investigate the cardiovascular outcomes associated with deferred or performed coronary revascularization based on intracoronary physiology.

METHODS: Available studies were identified through a systematic search of PubMed, EMBASE, and CENTRAL. Efficacy outcomes investigated were major adverse cardiovascular events, all-cause death, cardiovascular death, noncardiovascular death, myocardial infarction, and unplanned revascularization.

RESULTS: A total of 24 studies enrolling 24 285 patients were included in the meta-analysis. After a mean±SD follow-up of 2.6±1.6 years, patients undergoing physiology-guided deferred revascularization show consistently better outcomes than patients who underwent revascularization, including all-cause death (incidence rate ratio [IRR], 1.14 [95% CI, 1.00-1.30]; P=0.05), cardiovascular death (IRR, 1.53 [95% CI, 1.17-2.00]; P=0.002), and unplanned revascularization (IRR, 1.38 [95% CI, 1.06-1.79]; P=0.01). For major adverse cardiovascular events (IRR, 1.15 [95% CI, 0.99-1.34]; P=0.07) and myocardial infarction (IRR, 1.24 [95% CI, 0.95-1.61]; P=0.11), the associations did not reach statistical significance.

CONCLUSIONS: Patients in whom revascularization was deferred based on intracoronary physiology show lower risk of adverse cardiovascular events compared with those who underwent revascularization. These findings suggest that pressure wire assessment has prognostic implications besides the indication for revascularization.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Journal of the American Heart Association
article number
e042044
pages
1 - 13
publisher
Wiley-Blackwell
external identifiers
  • pmid:42017344
ISSN
2047-9980
DOI
10.1161/JAHA.125.042044
language
English
LU publication?
yes
id
6047937c-0a6d-4234-8821-625ff37a6603
date added to LUP
2026-04-23 09:19:42
date last changed
2026-04-23 09:59:30
@article{6047937c-0a6d-4234-8821-625ff37a6603,
  abstract     = {{<p>BACKGROUND: Although large studies and pooled analyses of individual patient data have demonstrated the safety of deferring coronary revascularization based on a nonischemic intracoronary pressure index result, conflicting findings have emerged in specific patient subsets and with varying follow-up. Thus, we conducted an updated comprehensive systematic review and meta-analysis to investigate the cardiovascular outcomes associated with deferred or performed coronary revascularization based on intracoronary physiology.</p><p>METHODS: Available studies were identified through a systematic search of PubMed, EMBASE, and CENTRAL. Efficacy outcomes investigated were major adverse cardiovascular events, all-cause death, cardiovascular death, noncardiovascular death, myocardial infarction, and unplanned revascularization.</p><p>RESULTS: A total of 24 studies enrolling 24 285 patients were included in the meta-analysis. After a mean±SD follow-up of 2.6±1.6 years, patients undergoing physiology-guided deferred revascularization show consistently better outcomes than patients who underwent revascularization, including all-cause death (incidence rate ratio [IRR], 1.14 [95% CI, 1.00-1.30]; P=0.05), cardiovascular death (IRR, 1.53 [95% CI, 1.17-2.00]; P=0.002), and unplanned revascularization (IRR, 1.38 [95% CI, 1.06-1.79]; P=0.01). For major adverse cardiovascular events (IRR, 1.15 [95% CI, 0.99-1.34]; P=0.07) and myocardial infarction (IRR, 1.24 [95% CI, 0.95-1.61]; P=0.11), the associations did not reach statistical significance.</p><p>CONCLUSIONS: Patients in whom revascularization was deferred based on intracoronary physiology show lower risk of adverse cardiovascular events compared with those who underwent revascularization. These findings suggest that pressure wire assessment has prognostic implications besides the indication for revascularization.</p>}},
  author       = {{Lombardi, Marco and Travieso, Alejandro and Cerrato, Enrico and Mohammad, Moman A and Götberg, Matthias and Davies, Justin and Escaned, Javier}},
  issn         = {{2047-9980}},
  language     = {{eng}},
  month        = {{04}},
  pages        = {{1--13}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of the American Heart Association}},
  title        = {{Cardiovascular Outcomes in Patients With Deferred and Performed Coronary Revascularization Based on Intracoronary Physiology : A Systematic Review and Meta-Analysis}},
  url          = {{http://dx.doi.org/10.1161/JAHA.125.042044}},
  doi          = {{10.1161/JAHA.125.042044}},
  year         = {{2026}},
}