Shiono Yasutsugu, Kubo Takashi, Tanaka Atsushi, Ino Yasushi, Yamaguchi Tomoyuki, Tanimoto Takashi, Yamano Takashi, Matsuo Yoshiki, Nishiguchi Tsuyoshi, Teraguchi Ikuko, Ota Shingo, Ozaki Yuichi, Orii Makoto, Shimamura Kunihiro, Kitabata Hironori, Hirata Kumiko, Imanishi Toshio, Akasaka Takashi
Department of Cardiovascular Medicine, Wakayama Medical University.
Circ J. 2015;79(1):91-5. doi: 10.1253/circj.CJ-14-0671. Epub 2014 Nov 19.
A strategy of deferred percutaneous coronary intervention for coronary stenosis with fractional flow reserve (FFR) 0.75-0.80, termed the gray zone, remains a matter of debate. The aim of this study was to assess the safety of deferring revascularization for patients with FFR 0.75-0.80 compared with those with FFR >0.80.
We assessed 3-year clinical outcome in 150 patients with angiographically intermediate stenosis who had revascularization deferred on the basis of FFR ≥ 0.75 (FFR 0.75-0.80, n=56; FFR >0.80, n=94). Target vessel failure (TVF), defined as a composite of cardiac death, target vessel-related myocardial infarction (MI), and ischemia-driven target vessel revascularization (TVR) was evaluated during follow-up. Cardiac death was observed in 1 patient with FFR 0.75-0.80. There was no target vessel-related MI in either group. The incidence of ischemia-driven TVR was higher in patients with FFR 0.75-0.80 than in those with FFR >0.80 (14% vs. 3%, P=0.020). TVF-free survival was significantly worse for the patients with FFR 0.75-0.80 than those with FFR >0.80 (hazard ratio, 5.2; 95% confidence intervals: 1.4-19.5; P=0.015).
Patients with FFR 0.75-0.80 were at higher risk of TVF mainly due to TVR than those with FFR >0.80.
对于冠状动脉狭窄且血流储备分数(FFR)为0.75 - 0.80的情况,即所谓的“灰色地带”,采用延迟经皮冠状动脉介入治疗的策略仍存在争议。本研究的目的是评估与FFR >0.80的患者相比,FFR为0.75 - 0.80的患者延迟血运重建的安全性。
我们评估了150例血管造影显示中度狭窄且基于FFR≥0.75延迟血运重建的患者的3年临床结局(FFR 0.75 - 0.80,n = 56;FFR >0.80,n = 94)。随访期间评估目标血管失败(TVF),其定义为心源性死亡、目标血管相关心肌梗死(MI)和缺血驱动的目标血管血运重建(TVR)的复合终点。FFR为0.75 - 0.80的患者中有1例发生心源性死亡。两组均未发生目标血管相关MI。FFR为0.75 - 0.80的患者缺血驱动的TVR发生率高于FFR >0.80的患者(14%对3%,P = 0.020)。FFR为0.75 - 0.80的患者无TVF生存率显著低于FFR >0.80的患者(风险比,5.2;95%置信区间:1.4 - 19.5;P = 0.015)。
与FFR >0.80的患者相比,FFR为0.75 - 0.80的患者发生TVF的风险更高,主要原因是TVR。