Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
EuroIntervention. 2017 Oct 13;13(9):e1112-e1119. doi: 10.4244/EIJ-D-17-00110.
There are limited data on the prognosis of deferred non-culprit lesions in patients with acute coronary syndrome (ACS) based on fractional flow reserve (FFR). We aimed to investigate the prognosis of deferred non-culprit lesions in ACS patients, compared with deferred lesions in patients with stable coronary artery disease (SCAD), on the basis of FFR.
The clinical outcomes of 449 non-culprit lesions (301 patients with ACS) were compared with 2,484 lesions (1,295 patients with SCAD) in which revascularisation was deferred on the basis of a high FFR (>0.80). The primary outcome was major adverse cardiac events (MACE), a composite of cardiac death, target vessel-related myocardial infarction (MI) and ischaemia-driven revascularisation. Among the ACS population, 65.8% presented with unstable angina and 34.2% with non-ST-segment elevation MI. Mean angiographic percent diameter stenosis and FFR of the deferred lesions were 39.3±15.0% and 0.92±0.06, respectively. During the median follow-up duration of 722.0 days, the deferred non-culprit lesions of ACS patients showed a significantly higher rate of MACE (3.8% vs. 1.6%, HRadj 2.97, 95% CI: 1.23-7.17, p=0.016), mainly driven by the higher rate of ischaemia-driven revascularisation (2.8% vs. 1.1%, HRadj 3.39, 95% CI: 1.29-8.92, p=0.013) than the deferred lesions in SCAD patients. Regardless of the range of FFR in the deferred lesions (0.81-0.85, 0.86-0.90, 0.91-0.95, and 0.95-1.00), non-culprit lesions of ACS showed a more than twofold higher rate of MACE than that of SCAD. In a multivariable marginal Cox model, ACS was the most powerful independent predictor of MACE (HRadj 2.74, 95% CI: 1.13-6.64, p=0.026).
Compared to the deferred lesions of SCAD patients, deferred non-culprit lesions of ACS on the basis of FFR showed a higher rate of clinical events, regardless of FFR range.
基于血流储备分数（FFR），目前关于急性冠脉综合征（ACS）患者非罪犯病变延迟治疗的预后数据有限。本研究旨在探讨基于 FFR 情况下，ACS 患者非罪犯病变延迟治疗的预后，并与稳定型冠状动脉疾病（SCAD）患者的延迟病变进行比较。
比较了 449 个非罪犯病变（301 例 ACS 患者）和 2484 个病变（1295 例 SCAD 患者）的临床结局，这些病变基于高 FFR（>0.80）而延迟了血运重建。主要终点是主要不良心脏事件（MACE），即心脏死亡、靶血管相关心肌梗死（MI）和缺血驱动的血运重建的复合终点。ACS 人群中，65.8%表现为不稳定型心绞痛，34.2%为非 ST 段抬高型 MI。延迟病变的平均血管造影狭窄百分比和 FFR 分别为 39.3±15.0%和 0.92±0.06。在中位随访 722.0 天期间，ACS 患者的非罪犯病变的 MACE 发生率明显更高（3.8% vs. 1.6%，HRadj 2.97，95%CI：1.23-7.17，p=0.016），主要是由于缺血驱动的血运重建率较高（2.8% vs. 1.1%，HRadj 3.39，95%CI：1.29-8.92，p=0.013），高于 SCAD 患者的延迟病变。无论 FFR 范围如何（0.81-0.85、0.86-0.90、0.91-0.95 和 0.95-1.00），ACS 的非罪犯病变的 MACE 发生率均高于 SCAD。在多变量边际 Cox 模型中，ACS 是非罪犯病变发生 MACE 的最强独立预测因子（HRadj 2.74，95%CI：1.13-6.64，p=0.026）。
与 SCAD 患者的延迟病变相比，基于 FFR 的 ACS 患者的非罪犯病变即使在 FFR 范围内，也表现出更高的临床事件发生率。
