Xiu Jiancheng, Chen Gangbin, Zheng Hua, Wang Yuegang, Chen Haibin, Liu Xuewei, Wu Juefei, Bin Jianping
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Clin Invest Med. 2016 Feb 1;39(1):E25-36. doi: 10.25011/cim.v39i1.26327.
Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is used to assess the need for angioplasty in vessels with intermediate blockages. The treatment outcomes of FFR-guided vs. conventional angiography-guided PCI were evaluated in patients with multi-vessel coronary artery disease (CAD).
Prospective and retrospective studies comparing FFR-guided vs. angiography-guided PCI in patients with multi-vessel CAD were identified from medical databases by two independent reviewers using the terms "percutaneous coronary intervention, fractional flow reserve, angiography, coronary heart disease, major adverse cardiac events (MACE) and myocardial infarction". The primary outcome was the number of stents placed, and the secondary outcomes were procedure time, mortality, myocardial infarction (MI) and MACE rates.
Seven studies (three retrospective and four prospective), which included 49,517 patients, were included in this review. A total of 4,755 patients underwent FFR, while 44,697 received angiography-guided PCI. The mean patient age ranged from 58 to 71.7 years. The average number of stents used in FFR patients ranged from 0.3-1.9, and in angiography-guided PCI patients ranged from 0.7-2.7. Analysis indicated there was a greater number of stents placed in the angiography-guided group compared with the FFR group (pooled difference in means: -0.64, 95% confidence interval [CI]: -0.81 to -0.47, P < 0.001). There were no differences in the secondary outcomes between the two groups.
Both procedures produce similar clinical outcomes, but the fewer number of stents used with FFR may have clinical as was as cost implications.
血流储备分数（FFR）指导下的经皮冠状动脉介入治疗（PCI）用于评估中度狭窄血管行血管成形术的必要性。本研究评估了多支冠状动脉疾病（CAD）患者中FFR指导下与传统血管造影指导下PCI的治疗效果。
两名独立评审员通过使用“经皮冠状动脉介入治疗、血流储备分数、血管造影、冠心病、主要不良心脏事件（MACE）和心肌梗死”等术语，从医学数据库中识别出比较多支CAD患者中FFR指导下与血管造影指导下PCI的前瞻性和回顾性研究。主要结局是置入支架的数量，次要结局是手术时间、死亡率、心肌梗死（MI）和MACE发生率。
本综述纳入了7项研究（3项回顾性研究和4项前瞻性研究），共49517例患者。共有4755例患者接受了FFR，而44697例接受了血管造影指导下的PCI。患者平均年龄在58至71.7岁之间。FFR组患者使用的支架平均数量在0.3 - 1.9个之间，血管造影指导下PCI组患者使用的支架平均数量在0.7 - 2.7个之间。分析表明，与FFR组相比，血管造影指导组置入的支架数量更多（合并均值差异：-0.64，95%置信区间[CI]：-0.81至-0.47，P < 0.001）。两组的次要结局无差异。
两种手术产生相似的临床结局，但FFR使用的支架数量较少可能具有临床意义及成本效益。
