Pijls Nico H J, Klauss Volker, Siebert Uwe, Powers Eric, Takazawa Kenji, Fearon William F, Escaned Javier, Tsurumi Yukio, Akasaka Takashi, Samady Habib, De Bruyne Bernard
Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
Circulation. 2002 Jun 25;105(25):2950-4. doi: 10.1161/01.cir.0000020547.92091.76.
Coronary stenting is associated with a restenosis rate of 15% to 20% at 6-month follow-up, despite optimum angiographic stent implantation. In this multicenter registry, we investigated the relation between optimum physiological stent implantation as assessed by poststent fractional flow reserve (FFR) and outcome at 6 months.
In 750 patients, coronary pressure measurement at maximum hyperemia was performed after angiographically apparently satisfactory stent implantation. Poststenting FFR was calculated and related to major adverse events (including need for repeat target vessel revascularization) at 6 months. In 76 patients (10.2%), at least 1 adverse event occurred. Five patients died, 19 experienced myocardial infarction, and 52 underwent at least 1 repeat target vessel revascularization. By multivariate analysis, FFR immediately after stenting was the most significant independent variable related to all types of events. In 36% of the patients, FFR normalized (>0.95), and event rate was 4.9% in that group. In 32% of the patients, poststent FFR was between 0.90 and 0.95, and event rate was 6.2%. In 32% of patients, poststent FFR was <0.90, and event rate was 20.3%. In 6% of the patients, FFR was <0.80, and event rate was 29.5% (P<0.001).
FFR after stenting is a strong independent predictor of outcome at 6 months.
尽管冠状动脉支架植入术在血管造影下达到了最佳效果，但在6个月的随访中，其再狭窄率仍为15%至20%。在这个多中心注册研究中，我们调查了通过支架植入后血流储备分数（FFR）评估的最佳生理性支架植入与6个月时的预后之间的关系。
在750例患者中，在血管造影显示支架植入明显满意后，于最大充血时进行冠状动脉压力测量。计算支架植入后的FFR，并将其与6个月时的主要不良事件（包括再次进行靶血管血运重建的需求）相关联。76例患者（10.2%）发生了至少1次不良事件。5例患者死亡，19例发生心肌梗死，52例至少接受了1次再次靶血管血运重建。通过多变量分析，支架植入后即刻的FFR是与所有类型事件相关的最显著独立变量。36%的患者FFR恢复正常（>0.95），该组的事件发生率为4.9%。32%的患者支架植入后的FFR在0.90至0.95之间，事件发生率为6.2%。32%的患者支架植入后的FFR<0.90，事件发生率为20.3%。6%的患者FFR<0.80，事件发生率为29.5%（P<0.001）。
支架植入后的FFR是6个月时预后的有力独立预测指标。
