Department of Medicine, Division of Cardiology, State University of New York at Buffalo, and Buffalo VA Healthcare System, Buffalo, New York.
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Catheter Cardiovasc Interv. 2018 Oct 1;92(4):692-700. doi: 10.1002/ccd.27525. Epub 2018 Feb 6.
To determine if fractional flow reserve guided percutaneous coronary intervention (FFR-guided PCI) is associated with reduced ischemic myocardium compared with angiography-guided PCI.
Although FFR-guided PCI has been shown to improve outcomes, it remains unclear if it reduces the extent of ischemic myocardium at risk compared with angiography-guided PCI.
We evaluated 380 patients (190 FFR-guided PCI cases and 190 propensity-matched controls) who underwent PCI from 2009 to 2014. Clinical, laboratory, angiographic, stress testing, and major adverse cardiac events [MACE] (all-cause mortality, recurrence of MI requiring PCI, stroke) data were collected.
Mean age was 63 ± 11 years; the majority of patients were males (76%) and Caucasian (77%). Median duration of follow up was 3.4 [Range: 1.9, 5.0] years. Procedural complications including coronary dissection (2% vs. 0%, P = .12) and perforation (0% vs. 0%, P = 1.00) were similar between FFR-guided and angiography-guided PCI patients. FFR-guided PCI patients had lower unadjusted (14.7% vs. 23.2%, P = .04) and adjusted [OR = 0.58 (95% CI: 0.34-0.98)] risk of repeat revascularization at one year. FFR-guided PCI patients were less likely (23% vs. 32%, P = .02) to have ischemia and had lower (5.9% vs. 21.1%, P < .001) ischemic burden (moderate-severe ischemia) on post-PCI stress testing. Presence of ischemia post-PCI remained a strong predictor of MACE [OR = 2.14 (95%CI: 1.28-3.60)] with worse survival compared to those without ischemia (HR = 1.63 (95% CI: 1.06-2.51).
Compared with angiography-guided PCI, FFR-guided PCI results in less repeat revascularization and a lower incidence of post PCI ischemia translating into improved survival, without an increase in complications.
确定与血管造影指导下的经皮冠状动脉介入治疗（angiography-guided PCI）相比，分数血流储备指导的经皮冠状动脉介入治疗（FFR-guided PCI）是否与减少缺血性心肌相关。
尽管 FFR-guided PCI 已被证明可改善结果，但尚不清楚与血管造影指导下的 PCI 相比，它是否会减少缺血性心肌的范围。
我们评估了 2009 年至 2014 年间接受 PCI 的 380 名患者（190 名 FFR-guided PCI 病例和 190 名倾向匹配对照）。收集了临床、实验室、血管造影、压力测试和主要不良心脏事件（MACE）（全因死亡率、再次需要 PCI 的 MI 复发、中风）的数据。
平均年龄为 63±11 岁；大多数患者为男性（76%）和白人（77%）。中位随访时间为 3.4[范围：1.9，5.0]年。程序并发症包括冠状动脉夹层（2%与 0%，P=0.12）和穿孔（0%与 0%，P=1.00）在 FFR-guided 和血管造影指导下的 PCI 患者之间相似。FFR-guided PCI 患者的未调整（14.7%与 23.2%，P=0.04）和调整后[OR=0.58（95%CI：0.34-0.98）]一年时再次血运重建的风险较低。FFR-guided PCI 患者发生缺血的可能性较低（23%与 32%，P=0.02），并且在 PCI 后压力测试中缺血负担较低（5.9%与 21.1%，P<.001）。PCI 后存在缺血仍然是 MACE 的强烈预测因素[OR=2.14（95%CI：1.28-3.60）]，与无缺血相比，生存率较差（HR=1.63（95%CI：1.06-2.51）。
与血管造影指导下的 PCI 相比，FFR-guided PCI 导致的再次血运重建较少，并且 PCI 后缺血的发生率较低，从而导致生存率提高，并发症无增加。
