Division of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria.
Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
Catheter Cardiovasc Interv. 2022 Feb;99(3):730-735. doi: 10.1002/ccd.29864. Epub 2021 Jul 7.
To investigate the impact of invasive functional guidance for coronary artery bypass graft surgery (CABG) on graft failure.
Data on the impact of fractional flow reserve (FFR) in guiding CABG are still limited.
Systematic review and individual patient data meta-analysis were performed. Primary objective was the risk of graft failure, stratified by FFR. Risk estimates are reported as odds ratios (ORs) derived from the aggregated data using random-effects models. Individual patient data were analyzed using mixed effect model to assess relationship between FFR and graft failure. This meta-analysis is registered in PROSPERO (CRD42020180444).
Four prospective studies comprising 503 patients referred for CABG, with 1471 coronaries, assessed by FFR were included. Graft status was available for 1039 conduits at median of 12.0 [IQR 6.6; 12.0] months. Risk of graft failure was higher in vessels with preserved FFR (OR 5.74, 95% CI 1.71-19.29). Every 0.10 FFR units decrease in the coronaries was associated with 56% risk reduction of graft failure (OR 0.44, 95% CI 0.34 to 0.59). FFR cut-off to predict graft failure was 0.79.
Surgical grafting of coronaries with functionally nonsignificant stenoses was associated with higher risk of graft failure.
研究冠状动脉旁路移植术（CABG）中侵袭性功能指导对桥接失败的影响。
关于血流储备分数（FFR）指导 CABG 影响的数据仍然有限。
进行了系统评价和个体患者数据荟萃分析。主要目标是根据 FFR 分层的桥接失败风险。使用随机效应模型从汇总数据中得出风险估计值，报告为比值比（ORs）。使用混合效应模型分析个体患者数据，以评估 FFR 与桥接失败之间的关系。该荟萃分析已在 PROSPERO（CRD42020180444）中注册。
纳入了四项前瞻性研究，共纳入 503 例因 CABG 而接受 FFR 评估的患者，共涉及 1471 支冠状动脉。中位随访时间为 12.0[IQR 6.6；12.0]个月时，可获得 1039 个桥接的状态。在保留 FFR 的血管中，桥接失败的风险更高（OR 5.74，95%CI 1.71-19.29）。每支冠状动脉的 FFR 降低 0.10 单位，桥接失败的风险降低 56%（OR 0.44，95%CI 0.34-0.59）。预测桥接失败的 FFR 截断值为 0.79。
对功能性非狭窄冠状动脉进行手术桥接与桥接失败的风险增加有关。
