VA Boston Healthcare System, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Northport VA Medical Center, Northport, New York; Stony Brook University, Stony Brook, New York.
Ann Thorac Surg. 2021 Sep;112(3):701-707. doi: 10.1016/j.athoracsur.2020.12.011. Epub 2020 Dec 23.
This subanalysis of the Randomized On-Off Bypass (ROOBY) trial examined transit time flow measurement (TTFM) use and its impact on graft patency and long-term clinical outcomes after coronary artery bypass graft surgery.
Use of TTFM for ROOBY centers and surgeons was assessed. Comparative patient outcomes based on TTFM use included 1-year graft patency and 1-year and 5-year major adverse cardiac events: all-cause mortality, nonfatal myocardial infarction, and revascularization (percutaneous coronary intervention or repeat coronary artery bypass graft surgery).
Transit time flow measurement was used in 1067 patients (TTFM group) and not used in 501 patients (non-TTFM group); of the TTFM group, median percentage TTFM use was 79% (interquartile range, 41% to 98%) among 18 Veterans Affairs Medical Centers, and 74% (interquartile range, 13% to 98%) among 48 surgeons. Patients were comparable in age (63 ± 8.5 years TTFM vs 62 ± 8 years non-TTFM, P = .30) and estimated 30-day mortality risk (1.8 ± 1.7 TTFM vs 1.9 non-TTFM, P = .53). One-year FitzGibbon A patency was 83% (1600 of 1988 grafts) for TTFM assessed grafts and 78% (629 of 803) for non-TTFM assessed grafts (P < .01). Fewer TTFM patients had an occluded graft (29%, vs 38% non-TTFM; P = .01). Comparing TTFM patients with non-TTFM patients, 5-year major adverse cardiac event rates were 30% vs 25% (P = .06). Individual component rates were 14% vs 11% for death (P = .06), 12% vs 8.8% for myocardial infarction (P = .07), and 13% vs 12% for revascularization (P = .62).
The association of TTFM use with graft patency and clinical outcome is uncertain. Future randomized studies that account for patient risk factors and practice variation would help address this knowledge gap.
本研究对随机开通-关闭旁路（ROOBY）试验进行了亚组分析，旨在探讨经皮冠状动脉血流储备分数（FFR）测量在冠状动脉旁路移植术后桥血管通畅性和长期临床结局中的作用。
评估 ROOBY 中心和外科医生对经皮冠状动脉血流储备分数（FFR）的使用情况。根据经皮冠状动脉血流储备分数（FFR）的使用情况比较患者的预后，包括 1 年桥血管通畅率和 1 年及 5 年主要不良心脏事件：全因死亡率、非致死性心肌梗死和血运重建（经皮冠状动脉介入治疗或再次冠状动脉旁路移植术）。
1067 例患者（FFR 组）使用了经皮冠状动脉血流储备分数（FFR）测量，501 例患者（非 FFR 组）未使用经皮冠状动脉血流储备分数（FFR）测量；在 FFR 组中，18 个退伍军人事务医疗中心的中位经皮冠状动脉血流储备分数（FFR）使用率为 79%（四分位距，41%至 98%），48 名外科医生的中位经皮冠状动脉血流储备分数（FFR）使用率为 74%（四分位距，13%至 98%）。两组患者年龄（FFR 组 63±8.5 岁，非 FFR 组 62±8 岁，P=0.30）和估计 30 天死亡率风险（FFR 组 1.8±1.7%，非 FFR 组 1.9%，P=0.53）相当。FFR 评估的桥血管 1 年 FitzGibbon A 通畅率为 83%（1600/1988 个桥血管），而非 FFR 评估的桥血管 1 年 FitzGibbon A 通畅率为 78%（629/803 个桥血管）（P<.01）。FFR 组闭塞桥血管的患者比例较少（29%，而非 FFR 组为 38%；P<.01）。与非 FFR 组相比，FFR 组患者 5 年主要不良心脏事件发生率为 30%比 25%（P=.06）。单独比较各组成部分的发生率，FFR 组死亡发生率为 14%，而非 FFR 组为 11%（P=.06）；FFR 组心肌梗死发生率为 12%，而非 FFR 组为 8.8%（P=.07）；FFR 组血运重建发生率为 13%，而非 FFR 组为 12%（P=.62）。
经皮冠状动脉血流储备分数（FFR）测量与桥血管通畅性和临床结局的关联尚不确定。未来的随机研究应考虑患者的风险因素和实践差异，这将有助于解决这一知识空白。
