Keimyung University Dongsan Medical Center, Daegu, Korea.
Am J Cardiol. 2011 Jun 15;107(12):1763-7. doi: 10.1016/j.amjcard.2011.02.329. Epub 2011 Apr 8.
Patients still present with drug-eluting stent (DES) failure despite an angiographically successful implantation. The aim of the present study was to investigate the relation between the fractional flow reserve (FFR) measured after DES implantation and the clinical outcomes at 1 year. A total of 80 patients (mean age 62 years, 74% men, 99 DESs) underwent coronary pressure measurement at maximum hyperemia after successful DES implantation. The composite of major adverse cardiac events (MACE), including death, myocardial infarction, and ischemia-driven target vessel revascularization was evaluated at 1 year. The patients were divided into 2 groups (low-FFR group, FFR ≤0.90 and high-FFR group, FFR >0.90) according to the median FFR. The mean poststent percent diameter stenosis was 11 ± 5% in the low-FFR group and 12 ± 3% in the high-FFR group (p = 0.31). Left anterior descending coronary artery lesions were more frequent in the low-FFR group than in the high-FFR group (82% vs 55%, p = 0.02). The mean stent length was greater in the low-FFR group than in the high-FFR group (38 ± 18 vs 28 ± 13 mm, p = 0.01). Six cases (7.5%) of MACE occurred during the 1-year follow-up. The rate of MACE was 12.5% in the low-FFR group and 2.5% in the high-FFR group (p <0.01). Receiver operating characteristic curves revealed 0.90 as the best cutoff of FFR after DES implantation for the prediction of 1-year MACE. In conclusion, a poststent FFR of ≤0.90 correlated with a greater adverse event rate at 1 year.
尽管经皮冠状动脉介入治疗(PCI)术后血管造影结果显示治疗成功,但患者仍可能出现药物洗脱支架(DES)失败。本研究旨在探讨 DES 植入术后测量的血流储备分数(FFR)与 1 年临床结局之间的关系。共有 80 名患者(平均年龄 62 岁,74%为男性,99 枚 DES)在成功植入 DES 后达到最大充血状态时接受冠状动脉压力测量。在 1 年内评估了主要不良心脏事件(MACE)的综合指标,包括死亡、心肌梗死和缺血驱动的靶血管血运重建。根据 FFR 的中位数,患者被分为低 FFR 组(FFR≤0.90)和高 FFR 组(FFR>0.90)。低 FFR 组的支架内术后狭窄率为 11±5%,高 FFR 组为 12±3%(p=0.31)。低 FFR 组的左前降支病变比高 FFR 组更常见(82%比 55%,p=0.02)。低 FFR 组的平均支架长度大于高 FFR 组(38±18 比 28±13 mm,p=0.01)。在 1 年随访期间,有 6 例(7.5%)发生 MACE。低 FFR 组的 MACE 发生率为 12.5%,高 FFR 组为 2.5%(p<0.01)。ROC 曲线显示,DES 植入术后 FFR 为 0.90 时,对 1 年 MACE 的预测最佳。总之,支架内 FFR≤0.90 与 1 年内不良事件发生率较高相关。