SYNTAX II 试验中的血管造影衍生的分数流储备：在三血管病变患者中，定量血流比的可行性、诊断性能和源自定量血流比的功能性 SYNTAX 评分的临床预后价值。
Angiography-Derived Fractional Flow Reserve in the SYNTAX II Trial: Feasibility, Diagnostic Performance of Quantitative Flow Ratio, and Clinical Prognostic Value of Functional SYNTAX Score Derived From Quantitative Flow Ratio in Patients With 3-Vessel Disease.
机构信息
Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan.
Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
出版信息
JACC Cardiovasc Interv. 2019 Feb 11;12(3):259-270. doi: 10.1016/j.jcin.2018.09.023.
OBJECTIVES
The aims of the present study were to investigate the applicability of quantitative flow ratio (QFR) in patients with 3-vessel disease and to demonstrate the impact of functional SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score derived from QFR (fSS) on clinical outcomes.
BACKGROUND
The applicability of QFR in patients with 3-vessel disease and the feasibility of fSS have not yet been investigated.
METHODS
All lesions interrogated using instantaneous wave-free ratio and/or fractional flow reserve in the SYNTAX II trial were retrospectively screened and analyzed for QFR. The diagnostic performance of QFR was investigated using hybrid wire-derived pressure assessment (instantaneous wave-free ratio and fractional flow reserve), used in the trial as a reference. Patients with analyzable QFR in 3 vessels were stratified according to fSS to evaluate its clinical prognostic value on the basis of 2-year patient-oriented composite endpoint.
RESULTS
QFRs were analyzable in 71.0% of lesions (836 lesions). The diagnostic performance of QFR to predict binary wire-based ischemia was substantial (area under the curve 0.81, accuracy 73.8%), with a positive predictive value of 85.9%. Independent predictors of diagnostic discordance were lesions in side branches, involvement of bifurcation or trifurcation, and small vessel. According to the 2-year patient-oriented composite endpoint, fSS reclassified 26.1% of the patients (36 of 138) in the high- to intermediate-risk group into the low-risk group appropriately (net reclassification improvement 0.32; p < 0.001). The area under the curve for fSS to predict the 2-year patient-oriented composite endpoint was higher than that of the classic anatomic SYNTAX score (0.68 vs. 0.56; p = 0.002).
CONCLUSIONS
QFR demonstrated substantial applicability in patients with 3-vessel disease. The fSS has the potential to further refine prognostic risk estimation compared with the classic anatomic SYNTAX score.
目的
本研究旨在探讨定量血流比（QFR）在三血管病变患者中的适用性，并展示由 QFR 衍生的功能 SYNTAX 评分（QFR 与经皮冠状动脉介入治疗和心脏手术之间的协同作用）（fSS）对临床结果的影响。
背景
QFR 在三血管病变患者中的适用性以及 fSS 的可行性尚未得到研究。
方法
回顾性筛选并分析了 SYNTAX II 试验中使用瞬时无波比和/或血流储备分数检测的所有病变，以进行 QFR 检测。使用试验中作为参考的混合导丝压力评估（瞬时无波比和血流储备分数）来研究 QFR 的诊断性能。根据 2 年以患者为导向的复合终点，根据 fSS 对 3 支血管中可分析 QFR 的患者进行分层，以评估其临床预后价值。
结果
71.0%（836 个病变）的病变可分析 QFR。QFR 预测二元导丝缺血的诊断性能较好（曲线下面积 0.81，准确性 73.8%），阳性预测值为 85.9%。诊断不一致的独立预测因素为侧支病变、分叉或三分叉病变以及小血管病变。根据 2 年以患者为导向的复合终点，fSS 将高至中危组的 26.1%（36 例）患者重新分类为低危组（净重新分类改善 0.32；p<0.001）。fSS 预测 2 年以患者为导向的复合终点的曲线下面积高于经典解剖 SYNTAX 评分（0.68 比 0.56；p=0.002）。
结论
QFR 在三血管病变患者中具有较好的适用性。与经典解剖 SYNTAX 评分相比，fSS 具有进一步改善预后风险评估的潜力。
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