Ahn Jung-Min, Yoon Sung-Han, Roh Jae-Hyung, Lee Pil Hyung, Chang Mineok, Park Hyun Woo, Lee Jong-Young, Kang Soo-Jin, Park Duk-Woo, Lee Seung-Whan, Kim Young-Hak, Lee Cheol Whan, Han Seungbong, Park Seong-Wook, Park Seung-Jung
Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Am J Cardiol. 2015 Oct 15;116(8):1163-71. doi: 10.1016/j.amjcard.2015.07.028. Epub 2015 Jul 27.
Impact of fractional flow reserve guidance on revascularization strategies and outcomes for severe coronary artery disease was unclear. We evaluate changes in treatment strategy and clinical outcomes and to compare the effectiveness between percutaneous coronary intervention (PCI) with second-generation drug-eluting stents and coronary artery bypass graft surgery (CABG) in severe coronary artery disease patients before and after routine use of FFR. From January 2008 to December 2011, we enrolled 2,612 patients with significant left main coronary artery disease or 3-vessel disease. We obtained data of patients before (from January 2008 to December 2009) and after (January 2010 to December 2011) the routine use of FFR. We used propensity score matching to compare the rate of primary outcomes (death, myocardial infarction, stroke, or repeat revascularization [Major adverse cardiovascular and cerebral event; MACCE]) at 1 year. Introduction of routine FFR use reduced the proportion of patients receiving CABG from 54% to 43% (p <0.001). The risk of MACCE before routine FFR use was significantly higher in the PCI group than the CABG group (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.09 to 3.03, p = 0.021), whereas that after routine FFR use was not significantly different between the groups (HR 1.22, 95% CI 0.59 to 2.52, p = 0.59). The risk of MACCE in patients receiving revascularization lowered after routine FFR use compared with that before (HR 0.57, 95% CI 0.38 to 0.85, p = 0.005). In conclusion, routine incorporation of FFR resulted in improved PCI outcomes, comparable with concurrent CABG in patients with severe coronary artery disease who received revascularization.
血流储备分数（FFR）指导对严重冠状动脉疾病血运重建策略及预后的影响尚不清楚。我们评估了治疗策略和临床结局的变化，并比较了在严重冠状动脉疾病患者中常规使用FFR前后，经皮冠状动脉介入治疗（PCI）联合第二代药物洗脱支架与冠状动脉旁路移植术（CABG）的有效性。2008年1月至2011年12月，我们纳入了2612例患有严重左主干冠状动脉疾病或三支血管病变的患者。我们获取了患者在常规使用FFR之前（2008年1月至2009年12月）和之后（2010年1月至2011年12月）的数据。我们采用倾向评分匹配法比较1年时主要结局（死亡、心肌梗死、中风或再次血运重建[主要不良心血管和脑血管事件；MACCE]）的发生率。常规使用FFR后，接受CABG的患者比例从54%降至43%（p<0.001）。在常规使用FFR之前，PCI组MACCE的风险显著高于CABG组（风险比[HR]1.82，95%置信区间[CI]1.09至3.03，p = 0.021），而在常规使用FFR之后，两组之间无显著差异（HR 1.22，95%CI 0.59至2.52，p = 0.59）。与常规使用FFR之前相比，接受血运重建的患者在常规使用FFR后MACCE的风险降低（HR 0.57，95%CI 0.38至0.85，p = 0.005）。总之，常规纳入FFR可改善PCI结局，与接受血运重建的严重冠状动脉疾病患者同期进行CABG的结局相当。
