药物洗脱支架植入后即刻测量血流储备分数对冠心病患者临床事件的截断值和长期预测：来自 DKCRUSH VII 注册研究的 1 至 3 年结果。
Cutoff Value and Long-Term Prediction of Clinical Events by FFR Measured Immediately After Implantation of a Drug-Eluting Stent in Patients With Coronary Artery Disease: 1- to 3-Year Results From the DKCRUSH VII Registry Study.
机构信息
Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Division of Cardiology, Jintan People's Hospital, Jintan, China.
Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
出版信息
JACC Cardiovasc Interv. 2017 May 22;10(10):986-995. doi: 10.1016/j.jcin.2017.02.012. Epub 2017 Apr 26.
OBJECTIVES
This study aimed to investigate the cutoff of post-drug-eluting stent (DES) fractional flow reserve (FFR) for prediction of 1- to 3-year target vessel failure (TVF).
BACKGROUND
FFR immediately after a DES implantation correlates with clinical events. However, the cutoff of post-DES FFR for predicting long-term clinical events remains understudied.
METHODS
Between May 2012 and September 2013, a total of 1,476 patients who had FFR <0.8 at maximal and at baseline underwent DES implantation were prospectively studied in 9 centers. Post-DES FFR was repeat measured. The primary endpoint was the 1-year TVF rate after procedures. Receiver-operating characteristic curves were used to calculate the post-DES FFR value for TVF, then patients were classified on the basis of this value and followed up for 3 years.
RESULTS
By the end of the first year, 88 (6.0%) TVFs were recorded. A post-DES FFR ≤0.88 strongly correlated with TVF. Disease in the left anterior descending coronary artery (LAD), stent length, and stent diameter were independent factors of impaired post-DES FFR, whereas post-procedure FFR ≤0.88 was the only predictor of TVF, with 40 (4.0%) TVFs in the FFR >0.88 and 48 (8.0%) in the FFR ≤0.88 group (p = 0.001), mainly driven by target vessel revascularization (3.8% vs. 8.8%; p = 0.005) and cardiac death (0.2% vs. 1.3%; p = 0.017). The difference in TVF between 2 groups was maintained through 3-year follow-up (p = 0.002). For patients with LAD lesions, a post-DES FFR ≤0.905 predicted 1-year TVF.
CONCLUSIONS
Post-DES FFR strongly correlated with TVF rate. Mechanisms attributed to and treatments for impaired FFR after stenting should be studied in future studies. (Post-DES FFR Predicts the Clinical Outcomes: DK CRUSH-VII, A Prospective, Multicenter, Registry Study [DK CRUSH-VII]; ChiCTR-PRCH-12001976).
目的
本研究旨在探讨药物洗脱支架（DES）后血流储备分数（FFR）的截断值对 1 至 3 年靶血管失败（TVF）的预测价值。
背景
DES 植入后即刻的 FFR 与临床事件相关。然而，用于预测长期临床事件的 DES 后 FFR 截断值仍研究不足。
方法
2012 年 5 月至 2013 年 9 月，前瞻性纳入 9 家中心共 1476 例 FFR 在最大充血和基线时＜0.8 的患者，这些患者接受了 DES 植入。重复测量 DES 后的 FFR。主要终点是术后 1 年的 TVF 发生率。使用受试者工作特征曲线计算 TVF 的 DES 后 FFR 值，然后根据该值对患者进行分类，并随访 3 年。
结果
在第 1 年末，记录到 88 例（6.0%）TVF。DES 后 FFR≤0.88 与 TVF 强烈相关。左前降支（LAD）病变、支架长度和支架直径是影响 DES 后 FFR 的独立因素，而术后 FFR≤0.88 是 TVF 的唯一预测因素，FFR＞0.88 组有 40 例（4.0%）TVF，FFR≤0.88 组有 48 例（8.0%）（p=0.001），主要由靶血管血运重建（3.8%比 8.8%；p=0.005）和心脏性死亡（0.2%比 1.3%；p=0.017）导致。两组间 TVF 的差异在 3 年随访中保持一致（p=0.002）。对于 LAD 病变患者，DES 后 FFR≤0.905 预测 1 年 TVF。
结论
DES 后 FFR 与 TVF 发生率密切相关。未来的研究应探讨导致支架后 FFR 受损的机制和治疗方法。（DES 后 FFR 预测临床结局：DK CRUSH-VII，一项前瞻性、多中心、登记研究[DK CRUSH-VII]；ChiCTR-PRCH-12001976）。
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