Keimyung University Dongsan Medical Center, Daegu, Korea.
JACC Cardiovasc Interv. 2010 Aug;3(8):812-7. doi: 10.1016/j.jcin.2010.04.016.
This study sought to evaluate the long-term clinical outcomes of a fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) strategy compared with intravascular ultrasound (IVUS)-guided PCI for intermediate coronary lesions.
Both FFR- and IVUS-guided PCI strategies have been reported to be safe and effective in intermediate coronary lesions.
The study included 167 consecutive patients, with intermediate coronary lesions evaluated by FFR or IVUS (FFR-guided, 83 lesions vs. IVUS-guided, 94 lesions). Cutoff value of FFR in FFR-guided PCI was 0.80, whereas that for minimal lumen cross sectional area in IVUS-guided PCI was 4.0 mm(2). The primary outcome was defined as a composite of major adverse cardiac events including death, myocardial infarction, and ischemia-driven target vessel revascularization at 1 year after the index procedure.
Baseline percent diameter stenosis and lesion length were similar in both groups (51 +/- 8% and 24 +/- 12 mm in the FFR group vs. 52 +/- 8% and 24 +/- 13 mm in the IVUS group, respectively). However, the IVUS-guided group underwent revascularization therapy significantly more often (91.5% vs. 33.7%, p < 0.001). No significant difference was found in major adverse cardiac event rates between the 2 groups (3.6% in FFR-guided PCI vs. 3.2% in IVUS-guided PCI). Independent predictors for performing intervention were guiding device: FFR versus IVUS (relative risk [RR]: 0.02); left anterior descending coronary artery versus non-left anterior descending coronary artery disease (RR: 5.60); and multi- versus single-vessel disease (RR: 3.28).
Both FFR- and IVUS-guided PCI strategy for intermediate coronary artery disease were associated with favorable outcomes. The FFR-guided PCI reduces the need for revascularization of many of these lesions.
本研究旨在评估与血管内超声（IVUS）指导下的经皮冠状动脉介入治疗（PCI）相比，血流储备分数（FFR）指导下的 PCI 策略治疗中度冠状动脉病变的长期临床结局。
已有研究报道，FFR 和 IVUS 指导下的 PCI 策略在治疗中度冠状动脉病变时均安全有效。
该研究纳入了 167 例连续患者，其中度冠状动脉病变通过 FFR 或 IVUS 进行评估（FFR 指导组 83 例病变，IVUS 指导组 94 例病变）。FFR 指导下 PCI 的 FFR 截断值为 0.80，而 IVUS 指导下 PCI 的最小管腔横截面积截断值为 4.0 mm²。主要终点定义为索引手术后 1 年内包括死亡、心肌梗死和缺血驱动的靶血管血运重建在内的主要不良心脏事件的复合终点。
两组患者的基线狭窄百分比和病变长度相似（FFR 组为 51±8%和 24±12 mm，IVUS 组为 52±8%和 24±13 mm）。然而，IVUS 指导组接受血运重建治疗的比例显著更高（91.5% vs. 33.7%，p<0.001）。两组间主要不良心脏事件发生率无显著差异（FFR 指导 PCI 为 3.6%，IVUS 指导 PCI 为 3.2%）。影响进行介入治疗的独立预测因素包括：指导设备（FFR 与 IVUS）（相对风险[RR]：0.02）；左前降支冠状动脉与非左前降支冠状动脉疾病（RR：5.60）；以及多支血管病变与单支血管病变（RR：3.28）。
对于中度冠状动脉疾病，FFR 和 IVUS 指导下的 PCI 策略均有良好的预后。FFR 指导下的 PCI 减少了许多病变需要血运重建的可能性。
