Kennedy Mark W, Fabris Enrico, Hermanides Renicus S, Kaplan Emel, Borren Nanette, Berta Balazs, Koopmans Petra C, Ottervanger Jan Paul, Suryapranata Harry, Kedhi Elvin
Isala Hartcentrum, Zwolle, The Netherlands.
Diagram CRO, Zwolle, The Netherlands.
Catheter Cardiovasc Interv. 2017 Dec 1;90(7):1077-1083. doi: 10.1002/ccd.27002. Epub 2017 Mar 17.
To explore the predictors of deferred lesion failure (DLF) in patients with diabetes mellitus (DM) and lesions with a fractional flow reserve (FFR) >0.80 and to examine whether a predictive relationship between negative FFR values (>0.80-1.00) and DLF exists.
DM is associated with rapidly progressive atherosclerosis and predictors of DLF in FFR negative lesions in this high-risk group are unknown.
All DM patients who underwent FFR-assessment between 1/01/2010 and 31/12/2013 were included, and followed until 1/7/2015. Patients carrying ≥1 FFR negative lesion(s) were assessed for DLF, and multivariate models used to identify independent factors associated with DLF.
A total of 205 patients with 252 FFR >0.80 lesions were identified. At a mean follow-up of 3.1 ± 1.4 years, DLF occurred in 29/205 (14.1%) patients, 31/252 (12.3%) lesions. Using marginal Cox regression multivariate analysis, insulin requiring DM [HR 2.24 (95%CI; 1.01-4.95), P = 0.046] and prior revascularization [HR 2.70 (95%CI 1.21-6.01), P = 0.015] were identified as being associated with a higher incidence of DLF. Absolute FFR values in FFR negative lesions in DM patients are not predictive of DLF (receiver operating characteristics curve analysis: area under the curve: 0.57 ± 0.06, 95%CI 0.46-0.69).
In DM patients with FFR negative lesions, insulin requiring DM and prior revascularization are predictors for DLF. In contrast to non-DM patients, no predictive relationship between absolute negative FFR values (ranging >0.80-1.00) and the risk of DLF exists in DM patients. © 2017 Wiley Periodicals, Inc.
探讨糖尿病（DM）患者且血流储备分数（FFR）>0.80的病变延迟病变失败（DLF）的预测因素，并检验FFR阴性值（>0.80 - 1.00）与DLF之间是否存在预测关系。
DM与快速进展的动脉粥样硬化相关，在这个高危组中，FFR阴性病变中DLF的预测因素尚不清楚。
纳入2010年1月1日至2013年12月31日期间接受FFR评估的所有DM患者，并随访至2015年7月1日。对携带≥1个FFR阴性病变的患者进行DLF评估，并使用多变量模型识别与DLF相关的独立因素。
共识别出205例患者有252个FFR>0.80的病变。平均随访3.1±1.4年，29/205（14.1%）例患者、31/252（12.3%）个病变发生了DLF。使用边际Cox回归多变量分析，需用胰岛素的DM [风险比（HR）2.24（95%置信区间；1.01 - 4.95），P = 0.046]和既往血运重建[HR 2.70（95%置信区间1.21 - 6.01），P = 0.015]被确定与DLF的较高发生率相关。DM患者FFR阴性病变中的绝对FFR值不能预测DLF（受试者工作特征曲线分析：曲线下面积：0.57±0.06，95%置信区间0.46 - 0.69）。
在有FFR阴性病变的DM患者中，需用胰岛素的DM和既往血运重建是DLF的预测因素。与非DM患者不同，DM患者中绝对FFR阴性值（范围>0.80 - 1.00）与DLF风险之间不存在预测关系。©2017威利期刊公司
