Division of Cardiology, Xuanwu Hospital Capital Medical University, Beijing 100053, China.
Eur Heart J. 2013 May;34(18):1375-83. doi: 10.1093/eurheartj/eht005. Epub 2013 Jan 23.
Fractional flow reserve (FFR) is the reference standard for the assessment of the functional significance of coronary artery stenoses, but is underutilized in daily clinical practice. We aimed to study long-term outcomes of FFR-guided percutaneous coronary intervention (PCI) in the general clinical practice.
In this retrospective study, consecutive patients (n = 7358), referred for PCI at the Mayo Clinic between October 2002 and December 2009, were divided in two groups: those undergoing PCI without (PCI-only, n = 6268) or with FFR measurements (FFR-guided, n = 1090). The latter group was further classified as the FFR-Perform group (n = 369) if followed by PCI, and the FFR-Defer group (n = 721) if PCI was deferred. Clinical events were compared during a median follow-up of 50.9 months. The Kaplan-Meier fraction of major adverse cardiac events at 7 years was 57.0% in the PCI-only vs. 50.0% in the FFR-guided group (P = 0.016). Patients with FFR-guided interventions had a non-significantly lower rate of death or myocardial infarction compared with those with angiography-guided interventions [hazard ratio (HR): 0.85, 95% CI: 0.71-1.01, P = 0.06]; the FFR-guided deferred-PCI strategy was independently associated with reduced rate of myocardial infarction (HR: 0.46, 95% CI: 0.26-0.82, P = 0.008). After excluding patients with FFR of 0.75-0.80 and deferring PCI, the use of FFR was significantly associated with reduced rate of death or myocardial infarction (HR: 0.80, 95% CI: 0.66-0.96, P = 0.02).
In the contemporary practice, an FFR-guided treatment strategy is associated with a favourable long-term outcome. The current study supports the use of the FFR for decision-making in patients undergoing cardiac catheterization.
血流储备分数（FFR）是评估冠状动脉狭窄功能意义的参考标准，但在日常临床实践中并未得到充分利用。本研究旨在研究 FFR 指导下经皮冠状动脉介入治疗（PCI）在一般临床实践中的长期结果。
在这项回顾性研究中，连续纳入 2002 年 10 月至 2009 年 12 月期间在梅奥诊所接受 PCI 的患者（n=7358），分为两组：未行 FFR 测量的单纯 PCI 组（n=6268）和行 FFR 测量的 FFR 指导组（n=1090）。后者进一步分为 FFR-Perform 组（n=369），如果进行 PCI 则归入该组，FFR-Defer 组（n=721），如果延迟 PCI 则归入该组。在中位随访 50.9 个月期间比较临床结局。7 年时主要不良心脏事件的 Kaplan-Meier 比例在单纯 PCI 组为 57.0%，FFR 指导组为 50.0%（P=0.016）。与血管造影指导的 PCI 相比，FFR 指导的 PCI 患者的死亡率或心肌梗死发生率较低[风险比（HR）：0.85，95%可信区间：0.71-1.01，P=0.06]；FFR 指导的延迟 PCI 策略与心肌梗死发生率降低独立相关[HR：0.46，95%可信区间：0.26-0.82，P=0.008]。排除 FFR 为 0.75-0.80 和延迟 PCI 的患者后，FFR 的使用与降低死亡率或心肌梗死发生率显著相关[HR：0.80，95%可信区间：0.66-0.96，P=0.02]。
在当代实践中，FFR 指导的治疗策略与良好的长期结局相关。本研究支持在接受心脏导管检查的患者中使用 FFR 进行决策。
