Pyxaras Stylianos A, Adriaenssens Tom, Barbato Emanuele, Ughi Giovanni Jacopo, Di Serafino Luigi, De Vroey Frederic, Toth Gabor, Tu Shengxian, Reiber Johan H C, Bax Jeroen J, Wijns William
Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium.
I Medizinische Klinik, Landshut-Achdorf Hospital, Landshut, Germany.
Int J Cardiovasc Imaging. 2018 Apr;34(4):495-502. doi: 10.1007/s10554-017-1262-4. Epub 2017 Oct 27.
We sought to assess in-stent variations in fractional flow reserve (FFR) in patients with previous percutaneous coronary intervention (PCI) and to associate any drop in FFR with findings by optical coherence tomography (OCT) imaging. Suboptimal post-PCI FFR values were previously associated with poor outcomes. It is not known to which extent in-stent pressure loss contributes to reduced FFR. In this single-arm observational study, 26 patients who previously underwent PCI with drug-eluting stent or scaffold implantation were enrolled. Motorized FFR pullback during continuous intravenous adenosine infusion and OCT assessments was performed. Post-PCI FFR < 0.94 was defined as suboptimal. At a median of 63 days after PCI (interquartile range: 59-64 days), 18 out of 26 patients (72%) had suboptimal FFR. The in-stent drop in FFR was significantly higher in patients with suboptimal FFR vs. patients with optimal FFR (0.08 ± 0.07 vs. 0.01 ± 0.02, p < 0.001). Receiver operating characteristic curve analysis showed that an in-stent FFR variation of > 0.03 was associated with suboptimal FFR. In patients with suboptimal FFR, the OCT analyses revealed higher mean neointimal area (respectively: 1.06 ± 0.80 vs. 0.51 ± 0.23 mm; p = 0.018) and higher neointimal thickness of covered struts (respectively 0.11 ± 0.07 vs. 0.06 ± 0.01 mm; p = 0.021). Suboptimal FFR values following stent-implantation are mainly caused by significant in-stent pressure loss during hyperemia. This finding is associated to a larger neointimal proliferation.
我们试图评估既往接受过经皮冠状动脉介入治疗（PCI）的患者支架内血流储备分数（FFR）的变化情况，并将FFR的任何下降与光学相干断层扫描（OCT）成像结果相关联。PCI术后FFR值未达最佳状态先前被认为与不良预后相关。目前尚不清楚支架内压力损失在多大程度上导致FFR降低。在这项单臂观察性研究中，纳入了26例既往接受过药物洗脱支架或支架植入术的PCI患者。在持续静脉输注腺苷期间进行了电动FFR回撤和OCT评估。PCI术后FFR＜0.94被定义为未达最佳状态。在PCI术后的中位63天（四分位间距：59 - 64天），26例患者中有18例（72%）的FFR未达最佳状态。FFR未达最佳状态的患者支架内FFR下降显著高于FFR达最佳状态的患者（0.08±0.07 vs. 0.01±0.02，p＜0.001）。受试者工作特征曲线分析显示，支架内FFR变化＞0.03与FFR未达最佳状态相关。在FFR未达最佳状态的患者中，OCT分析显示平均新生内膜面积更大（分别为：1.06±0.80 vs. 0.51±0.2
3mm；p = 0.018），覆盖支架的新生内膜厚度更高（分别为0.11±0.07 vs. 0.06±0.01mm；p = 0.021）。支架植入后FFR未达最佳状态主要是由充血期间显著的支架内压力损失引起的。这一发现与更大的新生内膜增生有关。
