Picchi Andrea, Leone Antonio Maria, Zilio Filippo, Cerrato Enrico, D'Ascenzo Fabrizio, Fineschi Massimo, Rigattieri Stefano, Ferlini Marco, Cameli Matteo, Calabria Paolo, Cresti Alberto, Limbruno Ugo
Division of Cardiology, Misericordia Hospital, Grosseto, Italy.
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
Int J Cardiol. 2017 Mar 1;230:335-338. doi: 10.1016/j.ijcard.2016.12.109. Epub 2016 Dec 22.
Revascularization of functionally non-significant stenoses in patients with stable coronary artery disease can safely be deferred as rate of adverse cardiovascular events is low. It is not clear whether fractional flow reserve (FFR) is just as accurate in acute coronary syndromes (ACS). The aim of this study is to assess the outcome of coronary lesions whose revascularization was deferred based on negative FFR values in subjects with ACS.
Patients with acute coronary syndrome and showing at least one coronary stenosis whose revascularization was deferred based on FFR value >0.80 were included in the study. The primary endpoint of the study was the rate of target lesion failure (TLF), a composite of cardiac events (cardiac death, myocardial infarction and any coronary revascularization) related to the initially deferred stenosis at three-year follow-up.
A total of 319 patients (237 male), mean age 68 [59-74] years and 355 coronary lesions with deferred revascularization based on negative FFR values (0.88±0.05) were selected. The rate of TLF was 6% at 1-year, 9% at 2-year and 12% at 3-year follow-up. TLF was driven by a new acute coronary syndrome in 75% of cases. The median time interval from FFR assessment to TLF was 457 [138-868] days.
In patients with acute coronary syndrome, the rate of TLF of the initially deferred coronary stenoses is 12% at 3-year follow-up and TLF occurred because of a new ACS in three quarters of cases.
在稳定型冠心病患者中，功能上无显著意义的狭窄病变的血运重建可安全推迟，因为不良心血管事件发生率较低。目前尚不清楚血流储备分数（FFR）在急性冠状动脉综合征（ACS）中是否同样准确。本研究的目的是评估在ACS患者中，基于FFR值为阴性而推迟血运重建的冠状动脉病变的结局。
纳入急性冠状动脉综合征且至少有一处基于FFR值>0.80而推迟血运重建的冠状动脉狭窄的患者。本研究的主要终点是靶病变失败（TLF）率，即三年随访时与最初推迟的狭窄相关的心脏事件（心源性死亡、心肌梗死和任何冠状动脉血运重建）的复合终点。
共入选319例患者（237例男性），平均年龄68[59 - 74]岁，以及355处基于FFR值为阴性（0.88±0.05）而推迟血运重建的冠状动脉病变。随访1年时TLF率为6%，2年时为9%，3年时为12%。75%的病例中，TLF是由新发急性冠状动脉综合征导致的。从FFR评估到TLF的中位时间间隔为457[138 - 868]天。
在急性冠状动脉综合征患者中，最初推迟的冠状动脉狭窄在三年随访时的TLF率为12%，且四分之三的病例中TLF是由新发ACS导致的。
