Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43 Gil, Songpa-Gu, Seoul, 05505, South Korea.
Department of Cardiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
Eur Heart J. 2017 Jul 1;38(25):1980-1989. doi: 10.1093/eurheartj/ehx139.
Fractional flow reserve (FFR) has proven to its prognostic and therapeutic value. However, the additive prognostic value of coronary flow reserve (CFR) remains unclear. This study sought to investigate the clinical utility of combined FFR and CFR measurements to predict outcomes.
Using the prospective, multicentre Interventional Cardiology Research Incooperation Society-FFR registry, a total of 2088 lesions from 1837 patients were included in this substudy. Based on baseline and hyperaemic pressure gradients, we computed physiologic limits of CFR [the so called pressure-bounded (pb) CFR] and classified lesions as low (<2) or high (≥2). The primary endpoint was major adverse cardiac events (MACE, a composite of cardiac death, myocardial infarction, and revascularization) analysed on a per-patient basis. During a median follow-up of 1.9 years (inter-quartile range: 1.0-3.0 years), MACE occurred in 5.7% of patients with FFR ≤0.80 vs. 2.8% of patients with FFR >0.80 [adjusted hazard ratio (aHR): 2.15, 95% confidence interval (CI): 1.19-3.89; P = 0.011. In contrast, the incidence of MACE did not differ between patients with pb-CFR < 2 vs. pb-CFR ≥ 2 (4.2% vs. 4.2%; aHR: 0.98, CI: 0.60 to 1.58; P = 0.92). Incorporation of FFR significantly improved model prediction of MACE (global χ2 38.8-48.1, P = 0.002). However, pb-CFR demonstrated no incremental utility to classify outcomes (global χ2 48.1-48.2, P > 0.99).
In this large, prospective registry of over 2000 coronary lesions, FFR was strongly associated with clinical outcomes. In contrast, a significant association between pb-CFR and clinical events could not be determined and adding knowledge of pb-CFR did not improve prognostication over FFR alone.
分流量储备（FFR）已被证明具有预后和治疗价值。然而，冠状动脉血流储备（CFR）的附加预后价值仍不清楚。本研究旨在探讨联合使用 FFR 和 CFR 测量值预测结局的临床实用性。
使用前瞻性、多中心介入心脏病学研究合作协会-FFR 注册中心，从 1837 名患者的 2088 个病变中纳入了这项亚组研究。基于基础状态和充血压力梯度，我们计算了 CFR 的生理限制[所谓的压力限制（pb）CFR]，并将病变分类为低（<2）或高（≥2）。主要终点是每例患者的主要不良心脏事件（MACE，包括心脏死亡、心肌梗死和血运重建）。在中位数为 1.9 年（四分位距：1.0-3.0 年）的随访期间，FFR≤0.80 的患者中发生 MACE 的比例为 5.7%，FFR>0.80 的患者为 2.8%[调整后的危险比（aHR）：2.15，95%置信区间（CI）：1.19-3.89；P=0.011]。相反，pb-CFR<2 与 pb-CFR≥2 的患者之间 MACE 的发生率无差异（4.2% vs. 4.2%；aHR：0.98，CI：0.60 至 1.58；P=0.92）。纳入 FFR 可显著改善 MACE 的模型预测（总体 χ2 38.8-48.1，P=0.002）。然而，pb-CFR 对结局分类没有增量效用（总体 χ2 48.1-48.2，P>0.99）。
在这项超过 2000 个冠状动脉病变的大型前瞻性注册研究中，FFR 与临床结局密切相关。相反，未能确定 pb-CFR 与临床事件之间存在显著关联，并且增加 pb-CFR 的知识并不能改善 FFR 单独预测的预后。
