Heart Institute, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, South Korea.
Eur Heart J. 2013 Nov;34(43):3353-61. doi: 10.1093/eurheartj/eht404. Epub 2013 Oct 2.
We evaluated the impact of the routine use of fractional flow reserve (FFR) on the practice and outcomes of percutaneous coronary intervention (PCI).
Between January 2008 and December 2011, the rate of FFR use during PCI increased from 1.9 to 50.7% after the introduction of routine FFR use (P < 0.001). A total of 5097 patients (2699 patients before and 2398 after the routine use of FFR) underwent PCI at an academic hospital in Korea; of those, stent implantation was deferred in 475 patients. We used propensity score (PS) matching to compare the rates of the primary endpoint [death, myocardial infarction (MI), or repeat revascularization] at 1 year the cohort before and after the routine use of FFR. In the PS-matched cohort (2178 pairs), the median number of lesions per patient was 2 [inter-quartile range (IQR) 1-2] before vs. 2 (IQR 1-2) after the routine FFR use (P = 0.68); the median number of stents implanted per patient was 2 (IQR 1-3) vs. 1 (IQR 1-2), respectively (P < 0.001). The rates of the primary endpoint at 1 year was significantly lower in patients after the routine FFR use vs. patients before the routine use of FFR (hazard ratio 0.55; 95% confidence interval 0.43-0.70; P < 0.001). This was primarily due to a reduction in peri-procedural MI and repeat revascularization.
Routine measurement of FFR in daily practice appeared to be associated with less use of stents and an improvement in clinical outcomes.
NCT 01788592.
评估常规使用血流储备分数（FFR）对经皮冠状动脉介入治疗（PCI）实践和结局的影响。
2008 年 1 月至 2011 年 12 月，在韩国一家学术医院，在常规使用 FFR 后，FFR 在 PCI 中的使用率从 1.9%增加到 50.7%（P<0.001）。共有 5097 名患者（常规使用 FFR 前 2699 例，后 2398 例）接受了 PCI；其中 475 例患者延迟了支架植入。我们使用倾向评分（PS）匹配比较了常规使用 FFR 前后队列的主要终点（1 年内死亡、心肌梗死（MI）或再次血运重建）发生率。在 PS 匹配队列（2178 对）中，每位患者的病变中位数为 2 [四分位距（IQR）1-2] ，常规 FFR 使用前 vs. 后分别为 2（IQR 1-2）（P=0.68）；每位患者的支架中位数分别为 2（IQR 1-3）和 1（IQR 1-2）（P<0.001）。常规 FFR 使用后患者的 1 年主要终点发生率明显低于常规 FFR 使用前患者（风险比 0.55；95%置信区间 0.43-0.70；P<0.001）。这主要是由于围手术期 MI 和再次血运重建减少。
在日常实践中常规测量 FFR 似乎与支架使用减少和临床结局改善有关。
临床试验.gov 编号：NCT 01788592。
