Doh Joon-Hyung, Nam Chang-Wook, Koo Bon-Kwon, Park Sang Hyun, Lee Ju-Hee, Han Jung-Kyu, Yang Hyoung-Mo, Lim Hong-Seok, Yoon Myeong-Ho, Cho Yun-Kyeong, Hur Seung-Ho, Lee Sung Yun, Kim Hyo-Soo, Tahk Seung-Jea
Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744 Korea.
J Invasive Cardiol. 2015 Sep;27(9):410-5.
Long-term clinical outcomes of real-world use of fractional flow reserve (FFR), including the decisions against FFR, have not been fully evaluated in the era of drug-eluting stent (DES) implantation.
A total of 1294 patients who underwent FFR measurement for de novo coronary lesions were included. FFR measured lesions (n = 1628) were divided into FFR-defer or FFR-stent lesions according to the treatment strategy selected after FFR measurement. Clinical outcomes were assessed by patient-related major adverse cardiac event (a composite of all-cause death, myocardial infarction, and any revascularization) and target-lesion related event (target-lesion related myocardial infarction and revascularization).
Mean FFR was 0.80 ± 0.12, and FFR was ≤0.8 in 728 lesions (44.7%). Five-year cumulative all-death rate was 6.3%, myocardial infarction rate was 1.5%, and rate of any revascularization was 12.5%. Among 797 deferred lesions, 105 lesions had FFR ≤0.8 and those lesions had a higher risk of 5-year target-lesion related events than the lesions with FFR >0.8 (21.2% vs 6.6%, respectively; P=.03). By multivariate analyses, the determinant for the 1-year target-lesion related events was the presence of diabetes (hazard ratio, 3.74; 95% confidence interval, 1.45-9.67; P=.01), while the determinant for delayed events at 1-5 years was FFR ≤0.8 (hazard ratio, 4.50; 95% confidence interval, 1.65-12.28; P=.01). Angiographic lesion severity was not an independent predictor for clinical events during follow-up among deferred lesions.
The deferral of stenting according to FFR was associated with favorable long-term outcomes. Presence of diabetes and low FFR (≤0.8) increased the risk of clinical events in deferred lesions.
在药物洗脱支架（DES）植入时代，血流储备分数（FFR）实际应用的长期临床结果，包括不采用FFR的决策，尚未得到充分评估。
纳入1294例因新发冠状动脉病变接受FFR测量的患者。根据FFR测量后选择的治疗策略，将测量FFR的病变（n = 1628）分为FFR延迟或FFR支架病变。通过患者相关的主要不良心脏事件（全因死亡、心肌梗死和任何血运重建的复合事件）和靶病变相关事件（靶病变相关心肌梗死和血运重建）评估临床结果。
平均FFR为0.80±0.12，728个病变（44.7%）的FFR≤0.8。五年累积全死亡率为6.3%，心肌梗死率为1.5%，任何血运重建率为12.5%。在797个延迟病变中，105个病变的FFR≤0.8，这些病变发生5年靶病变相关事件的风险高于FFR>0.8的病变（分别为21.2%和6.6%；P = 0.03）。通过多因素分析，1年靶病变相关事件的决定因素是糖尿病的存在（风险比，3.74；95%置信区间，1.45 - 9.67；P = 0.01），而1 - 5年延迟事件的决定因素是FFR≤0.8（风险比，4.50；95%置信区间，1.65 - 12.28；P = 0.01）。在延迟病变的随访期间，血管造影病变严重程度不是临床事件的独立预测因素。
根据FFR延迟支架植入与良好的长期结果相关。糖尿病的存在和低FFR（≤0.8）增加了延迟病变中临床事件的风险。
