"Città della Scienza e della Salute", Department of Cardiology, University of Turin, Turin, Italy.
"Città della Scienza e della Salute", Department of Cardiology, University of Turin, Turin, Italy.
Int J Cardiol. 2017 Oct 1;244:54-58. doi: 10.1016/j.ijcard.2017.05.108. Epub 2017 Jun 3.
To compare in patients with ACS (acute coronary syndromes) a PCI (percutaneous coronary intervention) approach based on FFR (fractional flow reserve) vs. one based on OCT (optical coherence tomography).
Consecutive patients admitted for ACS and treated with a PCI approach based on OCT or on FFR (recruited in two different studies) were compared and matched with propensity score analysis. Target Lesion revascularization (TLR) was the primary end point, while major adverse cardiovascular events [MACEs defined as the composite of death from cardiac causes, non-fatal MI, clinically driven target vessel revascularization (TVR), or re-hospitalization due to unstable angina] were the secondary ones. Sub-group analysis was performed for patients with FFR/OCT performed on culprit lesions and not. 285 patients were enrolled in the OCT-guided group and 335 in the FFR-guided group, 197 for each being selected after propensity score. After 25months (range: 7-39months), OCT-guided group were exposed to lower incidence of TLR (4.1% vs. 14.2% p<0.01) compared with FFR-guided group without impact on MACEs (14.2% vs. 14.2%, p=1) or all-cause death (3.6% vs. 1.1%, p=0.34). At Kaplan-Maier curve analysis for MACEs OCT-guided and FFR-guided groups showed similar outcomes (HR 1.19, CI 0.65-2.2, p=0.54). Subgroup analysis on culprit and not culprit vessel demonstrated consistent results.
An OCT based approach in ACS patients offers a reduction in TLR when compared to a PCI-FFR driven. These findings should be confirmed in randomized controlled trial.
比较急性冠状动脉综合征（ACS）患者中基于血流储备分数（FFR）与基于光学相干断层成像术（OCT）的经皮冠状动脉介入治疗（PCI）方法。
连续纳入因 ACS 接受基于 OCT 或 FFR 的 PCI 治疗的患者（分别在两项不同的研究中招募），并进行倾向评分分析匹配。主要终点为靶病变血运重建（TLR），次要终点为主要不良心血管事件（MACEs，定义为心脏原因死亡、非致死性心肌梗死、临床驱动的靶血管血运重建（TVR）或因不稳定型心绞痛再次住院的复合终点）。对行 FFR/OCT 的罪犯病变和非罪犯病变患者进行亚组分析。共纳入 285 例 OCT 指导组患者和 335 例 FFR 指导组患者，每组各有 197 例经倾向评分后入选。25 个月（范围：7-39 个月）后，OCT 指导组 TLR 发生率（4.1% vs. 14.2%，p<0.01）低于 FFR 指导组，但对 MACEs（14.2% vs. 14.2%，p=1）或全因死亡（3.6% vs. 1.1%，p=0.34）无影响。MACEs 的 Kaplan-Meier 曲线分析显示，OCT 指导组和 FFR 指导组的结果相似（HR 1.19，CI 0.65-2.2，p=0.54）。罪犯和非罪犯血管的亚组分析结果一致。
与基于 PCI-FFR 的治疗方法相比，ACS 患者中基于 OCT 的治疗方法可降低 TLR 发生率。这些发现应在随机对照试验中得到证实。
