The Heart Center, Rigshospitalet University Hospital, Copenhagen, Denmark.
EuroIntervention. 2016 Feb;11(11):e1257-66. doi: 10.4244/EIJV11I11A247.
Our aim was to investigate the strength of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) in daily practice.
For this study, 3,512 patients with stable CAD and at least one 50-89% coronary stenosis were identified; those patients thought to require PCI (n=1,716) were selected. Of these, 962 (56%) were treated based on angiography (XA) alone, whereas 754 patients (44%) had an FFR-guided treatment. In the latter group, 321 patients (43%) were reallocated to another treatment, predominantly medical treatment. After propensity score matching, the number of indicated lesions was 957 in the XA-guided group and 947 in the FFR-guided group. FFR guidance resulted in PCI deferral in 462 lesions (48.8%). In a seven-day landmark analysis, the rate of periprocedural myocardial infarction (MI) was less than half in the FFR-guided group (p>0.05). For the eight-day to four-year follow-up period, FFR guidance resulted in a significantly lower rate of the combined endpoint of death/MI (hazard ratio [HR] 0.63) and MI-driven target lesion revascularisation (HR 0.35).
This large, retrospective study shows that performing FFR has a significant impact on therapeutic strategy and demonstrates the favourable long-term outcome of FFR-guided PCI in an "all-comers" population of patients with stable CAD in daily clinical practice.
本研究旨在探讨在日常临床实践中，基于冠状动脉血流储备分数（FFR）的经皮冠状动脉介入治疗（PCI）在稳定型冠状动脉疾病（CAD）中的作用。
本研究纳入了 3512 例稳定性 CAD 且至少存在一处 50%-89%狭窄的患者，选择了其中需要进行 PCI 的患者（n=1716）。在这些患者中，有 962 例（56%）仅接受了血管造影（XA）指导的治疗，而 754 例（44%）患者接受了 FFR 指导的治疗。在后者组中，有 321 例（43%）患者重新分配到另一种治疗方法，主要是药物治疗。经过倾向评分匹配后，XA 指导组和 FFR 指导组的病变数量分别为 957 个和 947 个。FFR 指导使 462 个病变的 PCI 延迟（48.8%）。在 7 天的时间点分析中，FFR 指导组的围手术期心肌梗死（MI）发生率低于一半（p>0.05）。在 8 天至 4 年的随访期间，FFR 指导与死亡/MI 复合终点发生率显著降低相关（风险比[HR] 0.63）和 MI 驱动的靶病变血运重建（HR 0.35）。
这项大型回顾性研究表明，FFR 检测对治疗策略有显著影响，并证明了在日常临床实践中，在稳定性 CAD 的“所有患者”中，FFR 指导的 PCI 具有良好的长期预后。
