Lim Hong-Seok, Tonino Pim A L, De Bruyne Bernard, Yong Andy S C, Lee Bong-Ki, Pijls Nico H J, Fearon William F
Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States; Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea.
Catharina Hospital, Eindhoven, The Netherlands.
Int J Cardiol. 2014 Nov 15;177(1):66-70. doi: 10.1016/j.ijcard.2014.09.010. Epub 2014 Sep 20.
Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) improved outcomes compared with an angiography-guided strategy in patients with multivessel coronary artery disease (CAD). However, the effect of age on FFR has not been well-studied. We aimed to evaluate the impact of age on the favorable results of routine FFR-guided PCI for multivessel CAD.
We compared 1 year outcomes between FFR-guided PCI and angiography-guided PCI in the 512 patients enrolled in the FAME study <65 years old compared to the 493 patients ≥ 65 years old. We also evaluated the effect of age on the FFR result of varying degrees of visually estimated coronary stenosis.
The 1-year rate of death, myocardial infarction or repeat revascularization in the angiography-guided group tended to be higher than in the FFR-guided group for both those patients <65 (17.2% vs. 12.0%, P = 0.098) and those ≥ 65 years old (19.7% vs. 14.3%, P = 0.111) with no significant interaction based on age (P = 0.920). Older patients had higher FFR in vessels with 50% to 70% stenosis (0.83 ± 0.11 vs. 0.80 ± 0.13, P = 0.028) and in vessels with 71% to 90% stenosis (0.69 ± 0.15 vs. 0.65 ± 0.16, P = 0.002). The proportion of functionally significant lesions (FFR ≤ 0.80) in vessels with 71% to 90% stenosis was significantly lower in elderly compared to younger patients (75.3% vs. 84.1%, P = 0.013).
FFR-guided PCI is beneficial regardless of age, however, older patients have fewer functionally significant lesions, despite a similar angiographic appearance.
在多支冠状动脉疾病（CAD）患者中，与血管造影引导策略相比，血流储备分数（FFR）引导的经皮冠状动脉介入治疗（PCI）改善了治疗结果。然而，年龄对FFR的影响尚未得到充分研究。我们旨在评估年龄对多支CAD患者常规FFR引导PCI的良好结果的影响。
我们比较了FAME研究中512例年龄<65岁的患者和493例年龄≥65岁的患者中FFR引导PCI和血管造影引导PCI的1年结果。我们还评估了年龄对不同程度视觉估计冠状动脉狭窄的FFR结果的影响。
血管造影引导组中年龄<65岁（17.2%对12.0%，P = 0.098）和年龄≥65岁（19.7%对14.3%，P = 0.111）的患者1年死亡、心肌梗死或再次血运重建率均倾向于高于FFR引导组，且基于年龄无显著交互作用（P = 0.920）。老年患者在狭窄程度为50%至70%的血管中FFR较高（0.83±0.11对0.80±0.13，P = 0.028），在狭窄程度为71%至90%的血管中FFR也较高（0.69±0.15对0.65±0.16，P = 0.002）。与年轻患者相比，老年患者中狭窄程度为71%至90%的血管中功能上有意义的病变（FFR≤0.80）比例显著更低（75.3%对84.1%，P = 0.013）。
无论年龄大小，FFR引导的PCI都是有益的，然而，尽管血管造影表现相似，但老年患者功能上有意义的病变较少。
