ABC | Volume 111, Nº4, Octuber 2018

Original Article Martins ACS Fractional flow reserve-guided strategy Arq Bras Cardiol. 2018; 111(4):542-550 Figure 2 – Forest plots of the pooled risk ratio of the outcomes. (A) mortality, (B) cardiovascular mortality; (C) myocardial infarction; (D) target-vessel revascularization. Size of data markers reflects the relative weight of the study. CI indicates confidence interval. Study mortality myocardial infarction target lesion revascularization cardiovascular mortality Fischer JJ. et al, 2006 Sels et al, 2011 Van Belle et al, 2017 Overall Q = 0.51, p = 0.78, I2 = 0% Study Mehta et al, 2015 Fischer JJ. et al, 2006 Hakeem A. et al, 2006 Potvin JM. et al, 2006 Sels et al, 2011 Van Belle et al, 2017 Lee JM et al, 2017 Overall Q = 1.57, p = 0.96, I2 = 0% Study Mehta et al, 2015 Fischer et al, 2006 Hakeem A. et al, 2006 Lee JM et al, 2017 Potvin JM. et al, 2006 Overall Q = 13.21, p = 0.01, I2 = 70% Study Fischer JJ. et al, 2006 Hakeem A. et al, 2006 Potvin JM. et al, 2006 Lee JM et al, 2017 Sels et al, 2011 Overall Q = 6.55, p = 0.16, I2 = 39% 2 4 RR A 0 5 RR D 0 20 RR C RR B RR (95% Cl) % Weight 1.30 (0.33, 5.15) 12.5 1.24 (0.61, 2.50) 47.6 1.79 (0.83, 3.85) 40.0 100.0 1.44 (0.89, 2.35) RR (95% Cl) % Weight 1.84 (1.17, 2.90) 35.8 2.17 (0.14, 33.72) 1.0 2.61 (1.24, 5.52) 13.2 0.98 (0.09, 10.64) 1.3 1.69 (1.11, 2.57) 41.9 1.30 (0.34, 5.00) 4.1 2.15 (0.40, 11.69) 2.6 100.0 1.83 (1.39, 2.40) RR (95% Cl) % Weight 2.93 (1.33, 6.45) 37.5 4.34 (0.41, 46.31) 4.2 0.54 (0.26, 1.11) 44.5 0.17 (0.01, 4.00) 2.3 2.58 (0.62, 10.74) 11.5 100.0 1.29 (0.39, 4.25) RR (95% Cl) % Weight 1.86 (0.68, 5.13) 7.1 1.92 (0.95, 3.91) 14.6 0.77 (0.26, 1.11) 9.1 1.29 (0.91, 1.83) 60.5 3.44 (1.37, 8.65) 8.6 100.0 1.46 (0.93, 2.29) 0 20 40 and approximately two-thirds did not receive dual antiplatelet therapy. Moreover, several technical issues might explain the higher FFR cut-off values reported in these studies. 34,41-43 Despite most of the studies included did not report clinical outcomes by type of lesions (culprit or non-culprit) lesions, available evidence suggests, as previously mentioned, that in patients with ACS, microvascular dysfunction may be less marked, and the ability to achieve maximal hyperemia is sufficient to maintain the diagnostic use of FFR, both in culprit and non-culprit vessels. 44 Figure 3 – Forest plot of the pooled risk ratio for myocardial infarction injury. Size of data markers reflects the relative weight of the study. CI indicates confidence interval. Study RR RR (95% Cl) % Weight myocardial infarction lesion Mehta et al, 2015 Fischer JJ. et al, 2006 Potvin JM. et al, 2006 Overall Q = 0.05, p = 0.98, I2 = 0% 1.78 (0.76, 4.19) 88.6 2.14 (0.04, 105.66) 4.3 2.48 (0.12, 50.87) 7.1 100.0 1.84 (0.82, 4.11) 0 50 100 547