Hospital Universitário Pedro Ernesto - Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil.
Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, RJ - Brazil.
Arq Bras Cardiol. 2019 Jan;112(1):40-47. doi: 10.5935/abc.20180262. Epub 2018 Dec 17.
In multivessel disease patients with moderate stenosis, fractional flow reserve (FFR) allows the analysis of the lesions and guides treatment, and could contribute to the cost-effectiveness (CE) of non-pharmacological stents (NPS).
To evaluate CE and clinical impact of FFR-guided versus angiography-guided angioplasty (ANGIO) in multivessel patients using NPS.
Multivessel disease patients were prospectively randomized to FFR or ANGIO groups during a 5 year-period and followed for < 12 months. Outcomes measures were major adverse cardiac events (MACE), restenosis and CE.
We studied 69 patients, 47 (68.1%) men, aged 62.0 ± 9.0 years, 34 (49.2%) in FFR group and 53 (50.7%) in ANGIO group, with stable angina or acute coronary syndrome. In FFR, there were 26 patients with biarterial disease (76.5%) and 8 (23.5%) with triarterial disease, and in ANGIO, 24 (68.6%) with biarterial and 11 (31.4%) with triarterial disease. Twelve MACEs were observed - 3 deaths: 2 (5.8%) in FFR and 1 (2.8%) in ANGIO, 9 (13.0%) angina: 4(11.7%) in FFR and 5(14.2%) in ANGIO, 6 restenosis: 2(5.8%) in FFR and 4 (11.4%) in ANGIO. Angiography detected 87(53.0%) lesions in FFR, 39(23.7%) with PCI and 48(29.3%) with medical treatment; and 77 (47.0%) lesions in ANGIO, all treated with angioplasty. Thirty-nine (33.3%) stents were registered in FFR (0.45 ± 0.50 stents/lesion) and 78 (1.05 ± 0.22 stents/lesion) in ANGIO (p = 0.0001), 51.4% greater in ANGIO than FFR. CE analysis revealed a cost of BRL 5,045.97 BRL 5,430.60 in ANGIO and FFR, respectively. The difference of effectiveness was of 1.82%.
FFR reduced the number of lesions treated and stents, and the need for target-lesion revascularization, with a CE comparable with that of angiography.
在多支血管病变且中度狭窄的患者中，血流储备分数（FFR）可用于分析病变并指导治疗，有助于评估非药物支架（NPS）的成本效益（CE）。
评估在多支血管病变患者中使用 NPS 时，FFR 指导的血管成形术（ANGIO）与血管造影指导的 ANGIO 的 CE 和临床影响。
前瞻性地在 5 年期间将多支血管病变患者随机分为 FFR 或 ANGIO 组，并随访<12 个月。主要不良心脏事件（MACE）、再狭窄和 CE 是结局测量指标。
我们研究了 69 例患者，47 例（68.1%）为男性，年龄 62.0±9.0 岁，34 例（49.2%）在 FFR 组，53 例（50.7%）在 ANGIO 组，患有稳定性心绞痛或急性冠状动脉综合征。FFR 中有 26 例为双支血管病变（76.5%），8 例为三支血管病变（23.5%），ANGIO 中有 24 例为双支血管病变（68.6%），11 例为三支血管病变（31.4%）。观察到 12 例 MACE——3 例死亡：FFR 2 例（5.8%），ANGIO 1 例（2.8%），9 例心绞痛：FFR 4 例（11.7%），ANGIO 5 例（14.2%），6 例再狭窄：FFR 2 例（5.8%），ANGIO 4 例（11.4%）。造影在 FFR 中检测到 87 个（53.0%）病变，39 个（23.7%）行 PCI，48 个（29.3%）行药物治疗；ANGIO 中有 77 个（47.0%）病变，均行血管成形术治疗。FFR 中记录了 39 个（33.3%）支架（0.45±0.50 个支架/病变），ANGIO 中记录了 78 个（1.05±0.22 个支架/病变）（p=0.0001），ANGIO 比 FFR 多 51.4%。CE 分析显示，ANGIO 和 FFR 的成本分别为 BRL5045.97 和 BRL5430.60。有效性的差异为 1.82%。
FFR 减少了治疗病变和支架的数量，以及靶病变血运重建的需求，CE 与血管造影相当。
