Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China.
J Am Coll Cardiol. 2016 Mar 15;67(10):1158-1169. doi: 10.1016/j.jacc.2015.12.053.
The prognostic impact of microvascular status in patients with high fractional flow reserve (FFR) is not clear.
The goal of this study was to investigate the implications of coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) in patients who underwent FFR measurement.
Patients with high FFR (>0.80) were grouped according to CFR (≤2) and IMR (≥23 U) levels: group A, high CFR with low IMR; group B, high CFR with high IMR; group C, low CFR with low IMR; and group D, low CFR with high IMR. Patient-oriented composite outcome (POCO) of any death, myocardial infarction, and revascularization was assessed. The median follow-up was 658 days (interquartile range: 503.8 to 1,139.3 days).
A total of 313 patients (663 vessels) were assessed with FFR, CFR, and IMR. Correlation (r = 0.201; p < 0.001) and categorical agreement (kappa value = 0.178; p < 0.001) between FFR and CFR were modest. Low CFR was associated with higher POCO than high CFR (p = 0.034). There were no significant differences in clinical and angiographic characteristics among groups. Patients with high IMR with low CFR had the highest POCO (p = 0.002). Overt microvascular disease (p = 0.008), multivessel disease (p = 0.033), and diabetes mellitus (p = 0.033) were independent predictors of POCO. Inclusion of a physiological index significantly improved the discriminant function of a predictive model (relative integrated discrimination improvement 0.467 [p = 0.037]; category-free net reclassification index 0.648 [p = 0.007]).
CFR and IMR improved the risk stratification of patients with high FFR. Low CFR with high IMR was associated with poor prognosis. (Clinical, Physiological and Prognostic Implication of Microvascular Status; NCT02186093).
微血管状态对高分数血流储备（FFR）患者的预后影响尚不清楚。
本研究旨在探讨在进行 FFR 测量的患者中，冠状动脉血流储备（CFR）和微血管阻力指数（IMR）的意义。
根据 CFR（≤2）和 IMR（≥23 U）水平将 FFR 较高（>0.80）的患者分组：A 组，高 CFR 伴低 IMR；B 组，高 CFR 伴高 IMR；C 组，低 CFR 伴低 IMR；D 组，低 CFR 伴高 IMR。评估以患者为导向的复合终点（POCO）的任何死亡、心肌梗死和血运重建。中位随访时间为 658 天（四分位距：503.8 至 1139.3 天）。
共评估了 313 例患者（663 支血管）的 FFR、CFR 和 IMR。FFR 和 CFR 之间存在中度相关（r = 0.201；p < 0.001）和分类一致性（kappa 值 = 0.178；p < 0.001）。低 CFR 与高 CFR 相比，POCO 更高（p = 0.034）。各组间临床和血管造影特征无显著差异。高 IMR 伴低 CFR 的患者 POCO 最高（p = 0.002）。显性微血管疾病（p = 0.008）、多支血管病变（p = 0.033）和糖尿病（p = 0.033）是 POCO 的独立预测因素。生理指标的纳入显著提高了预测模型的判别能力（相对综合判别改善 0.467[ p = 0.037]；分类无净再分类指数 0.648[ p = 0.007]）。
CFR 和 IMR 改善了高 FFR 患者的风险分层。高 IMR 伴低 CFR 与预后不良相关。（微血管状态的临床、生理和预后意义；NCT02186093）。
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