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

Journal of the American Heart Association, Volume 15, Issue 9 , May 5, 2026. BackgroundAlthough 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.MethodsAvailable 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.ResultsA 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).