Neupane Saroj, Singh Hemindermeet, Edla Sushruth, Altujjar Mohammad, Yamsaki Hiroshi, Lalonde Thomas, Rosman Howard S, Eggebrecht Holger, Mehta Rajendra H
Department of Internal Medicine, Division of Cardiology, Henry Ford Hospital.
Cardiovascular Fellowship Program, Mercy-Health St Vincent Medical Center, Toledo, Ohio.
Coron Artery Dis. 2019 Sep;30(6):393-397. doi: 10.1097/MCA.0000000000000740.
Multivessel coronary artery disease is found in 30-50% of patients with ST-elevation myocardial infarction (MI) and is associated with adverse outcomes. It is not yet clear if outcomes are improved by utilizing fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) of noninfarct related artery (non-IRA) along with primary PCI.
To evaluate this, we performed a metanalysis of published randomized controlled trials by performing systematic search of PubMed, Medline, Google Scholar and Cochrane Central. Three studies met the inclusion criteria, with total of 1633 patients; 689 underwent FFR-guided complete revascularization and 944 underwent IRA only revascularization. FFR-guided PCI of non-IRA along with primary PCI led to significant reduction of major adverse cardiovascular events (composite of death, MI and repeat revascularization) compared to PCI of IRA only [odds ratio (OR) = 0.55; 95% confidence interval (CI) = 0.42-0.72; P < 0.001]. This difference was primarily due to significant reduction in repeat revascularization (OR = 0.37; 95% CI = 0.26-0.53; P < 0.001). The rates of all-cause mortality (OR = 1.24; 95% CI = 0.65-2.35; P = 0.51) and MI (OR = 0.79; 95% CI = 0.46-1.36; P = 0.48) were similar in two groups.
This meta-analysis demonstrated that FFR-guided PCI of non-IRA along with primary PCI was associated with lower rate of major adverse cardiovascular events compared with PCI of IRA-only in patients with ST-elevation MI and multivessel disease. The difference was driven by lower rate of repeat revascularization in FFR-guided PCI of non-IRA group.
在30%-50%的ST段抬高型心肌梗死（MI）患者中发现多支冠状动脉疾病，且其与不良预后相关。目前尚不清楚在进行直接经皮冠状动脉介入治疗（PCI）的同时，对非梗死相关动脉（非IRA）采用血流储备分数（FFR）引导的PCI是否能改善预后。
为评估这一点，我们通过对PubMed、Medline、谷歌学术和考克兰系统评价数据库进行系统检索，对已发表的随机对照试验进行了荟萃分析。三项研究符合纳入标准，共有1633例患者；689例接受了FFR引导的完全血运重建，944例仅接受了IRA血运重建。与仅对IRA进行PCI相比，在直接PCI的同时对非IRA进行FFR引导的PCI可显著降低主要不良心血管事件（死亡、MI和再次血运重建的复合事件）的发生率[比值比（OR）=0.55；95%置信区间（CI）=0.42-0.72；P<0.001]。这种差异主要是由于再次血运重建的显著减少（OR=0.37；95%CI=0.26-0.53；P<0.001）。两组的全因死亡率（OR=1.24；95%CI=0.65-2.35；P=0.51）和MI发生率（OR=0.79；95%CI=0.46-1.36；P=0.48）相似。
这项荟萃分析表明，在ST段抬高型MI和多支血管病变患者中，与仅对IRA进行PCI相比，在直接PCI的同时对非IRA进行FFR引导的PCI与较低的主要不良心血管事件发生率相关。这种差异是由非IRA组FFR引导的PCI中较低的再次血运重建率驱动的。
