Courtis Javier, Rodés-Cabau Josep, Larose Eric, Déry Jean-Pierre, Nguyen Can Manh, Proulx Guy, Gleeton Onil, Roy Louis, Barbeau Gerald, Noël Bernard, DeLarochellière Robert, Bertrand Olivier F
Interventional Cardiology Laboratories, Quebec Heart Institute, Laval Hospital, Quebec, Canada.
Catheter Cardiovasc Interv. 2008 Mar 1;71(4):541-8. doi: 10.1002/ccd.21406.
(1) To evaluate the clinical outcomes of patients with moderate coronary lesions and borderline fractional flow reserve (FFR) measurements (between 0.75 and 0.80), comparing those who underwent coronary revascularization (CR) to those who had medical treatment (MT), and (2) to determine the predictive factors of major adverse cardiac events (MACE) at follow-up.
A total of 107 consecutive patients (mean age 62 +/- 10 years) with at least one moderate coronary lesion (mean percent diameter stenosis 47 +/- 12%) evaluated by coronary pressure wire with FFR measurement between 0.75 and 0.80 (mean 0.77 +/- 0.02) were included in the study. MACE [CR, myocardial infarction (MI), cardiac death) and the presence of angina were evaluated at follow-up.
Sixty-three patients (59%) underwent CR and 44 patients (41%) had MT, with no clinical differences between groups. At a mean follow-up of 13 +/- 7 months, MACE related to the coronary lesion evaluated by FFR were higher in the MT group compared with CR group (23% vs. 5%, P = 0.005). Most MACE consisted of CRs, with no differences between groups in MI and cardiac death rate at follow-up. Both MT and FFR measurements in an artery supplying a territory with previous MI were independent predictive factors of MACE at follow-up, respectively (hazard ratio 5.2, 95% CI 1.4-18.9, P = 0.01; hazard ratio 4.1, 95% CI 1.1-15.3, P = 0.03). The presence of angina at follow-up was more frequent in the MT group compared with the CR group (41% vs. 9%, P = 0.002).
In patients with moderate coronary lesions and borderline FFR measurements deferral of revascularization was associated with a higher rate of MACE (CR) and a higher prevalence of angina at follow-up, especially in those with previous MI in the territory evaluated by FFR. Further prospective randomized studies should confirm whether or not an FFR cut-off point of 0.80 instead of 0.75 would be more appropriate for deferring CR in these cases.
（1）评估中度冠状动脉病变且血流储备分数（FFR）测量值处于临界范围（0.75至0.80之间）的患者的临床结局，比较接受冠状动脉血运重建（CR）的患者与接受药物治疗（MT）的患者；（2）确定随访时主要不良心脏事件（MACE）的预测因素。
本研究纳入了107例连续患者（平均年龄62±10岁），这些患者至少有一处中度冠状动脉病变（平均直径狭窄百分比47±12%），通过冠状动脉压力导丝评估，FFR测量值在0.75至0.80之间（平均0.77±0.02）。随访时评估MACE[CR、心肌梗死（MI）、心源性死亡]及心绞痛的发生情况。
63例患者（59%）接受了CR，44例患者（41%）接受了MT，两组间无临床差异。平均随访13±7个月时，MT组中与FFR评估的冠状动脉病变相关的MACE高于CR组（23%对5%，P = 0.005）。大多数MACE包括CR，随访时两组间MI和心源性死亡率无差异。MT以及供应既往有MI区域的动脉中的FFR测量值分别是随访时MACE的独立预测因素（风险比5.2，95%可信区间1.4 - 18.9，P = 0.01；风险比4.1，95%可信区间1.1 - 15.3，P = 0.03）。随访时MT组中心绞痛的发生率高于CR组（41%对9%，P = 0.002）。
在中度冠状动脉病变且FFR测量值处于临界范围的患者中，血运重建延迟与随访时较高的MACE（CR）发生率及较高的心绞痛患病率相关，尤其是在FFR评估区域既往有MI的患者中。进一步的前瞻性随机研究应证实对于这些病例，将FFR临界值设为0.80而非0.75以延迟CR是否更合适。
