Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
Catheter Cardiovasc Interv. 2021 Feb 1;97(2):247-256. doi: 10.1002/ccd.28753. Epub 2020 Jan 30.
The aim was to assess long-term outcome after deferring intervention of coronary lesions with a fractional flow reserve (FFR) value of >0.80 in a real-world patient population and then to identify factors associated with deferred target lesion failure (DTLF).
Deferring coronary interventions of intermediate lesions based on FFR measurement is safe, irrespective of the extent of coronary artery disease. However, FFR values near the cut-off of >0.80 may have less favorable outcome.
A retrospective analysis was performed in patients with deferred coronary intervention based on FFR value >0.80. The primary endpoint was DTLF, a composite of acute coronary syndrome (ACS) and any coronary revascularization, related to the initially deferred stenosis.
A total of 600 patients, mean age of 66 ± 10 years, and 751 coronary lesions with negative FFR values (mean 0.88 ± 0.04) were included. The mean follow-up was 27 ± 15 months. DTLF occurred in 44 patients (7.3%), revascularization in 42 (7%), and ACS without revascularization in 2 patients (0.3%). Patients with DTLF more often had diabetes mellitus, previous coronary artery bypass grafting, multivessel disease (MVD), and lower FFR at inclusion. Multivariable regression analysis showed that lower deferred FFR values [FFR 0.81-0.85: hazard ratio (HR) 2.79 (95% CI [confidence interval]; 1.46-5.32), p .002], MVD [HR 1.98 (95% CI; 1.05-3.75), p .036], distal lesions [HR 2.43 (95% CI; 1.29-4.57), p .006], and lesions located in a saphenous vein graft (SVG) [HR 6.35 (95% CI; 1.81-22.28), p .004] were independent predictors for DTLF.
The long-term rate of DTLF of initially deferred coronary lesions was 7.3%. Independent predictors for DTLF are lower deferred FFR value, the presence of MVD, distal lesions, and lesions in SVG.
评估在真实患者人群中，对血流储备分数（FFR）值＞0.80 的冠状动脉病变进行延迟干预后的长期结果，然后确定与延迟靶病变失败（DTLF）相关的因素。
基于 FFR 测量对中间病变进行延迟介入是安全的，无论冠状动脉疾病的程度如何。然而，FFR 值接近＞0.80 的临界点可能会有不太有利的结果。
对基于 FFR 值＞0.80 进行延迟冠状动脉介入的患者进行回顾性分析。主要终点是 DTLF，由最初延迟狭窄引起的急性冠脉综合征（ACS）和任何冠状动脉血运重建的复合事件。
共纳入 600 例患者，平均年龄 66±10 岁，751 处 FFR 值为阴性（平均 0.88±0.04）的冠状动脉病变。平均随访时间为 27±15 个月。44 例（7.3%）患者发生 DTLF，42 例（7%）患者进行血运重建，2 例（0.3%）患者发生无血运重建的 ACS。发生 DTLF 的患者更常患有糖尿病、既往冠状动脉旁路移植术、多支血管疾病（MVD）和较低的 FFR 值。多变量回归分析显示，较低的延迟 FFR 值[FFR 0.81-0.85：风险比（HR）2.79（95%置信区间（CI）；1.46-5.32），p=0.002]、MVD[HR 1.98（95% CI；1.05-3.75），p=0.036]、远端病变[HR 2.43（95% CI；1.29-4.57），p=0.006]和病变位于隐静脉桥（SVG）[HR 6.35（95% CI；1.81-22.28），p=0.004]是 DTLF 的独立预测因子。
最初延迟的冠状动脉病变的长期 DTLF 发生率为 7.3%。DTLF 的独立预测因子是较低的延迟 FFR 值、存在 MVD、远端病变和 SVG 中的病变。
