Cardiology, Aarhus University Hospital, Aarhus, Denmark
Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Heart. 2022 Feb;108(3):194-202. doi: 10.1136/heartjnl-2021-319773. Epub 2021 Oct 22.
To obtain more powerful assessment of the prognostic value of fractional flow reserve testing we performed a systematic literature review and collaborative meta-analysis of studies that assessed clinical outcomes of CT-derived calculation of FFR (FFR) (HeartFlow) analysis in patients with stable coronary artery disease (CAD).
We searched PubMed and Web of Science electronic databases for published studies that evaluated clinical outcomes following fractional flow reserve testing between 1 January 2010 and 31 December 2020. The primary endpoint was defined as 'all-cause mortality (ACM) or myocardial infarction (MI)' at 12-month follow-up. Exploratory analyses were performed using major adverse cardiovascular events (MACEs, ACM+MI+unplanned revascularisation), ACM, MI, spontaneous MI or unplanned (>3 months) revascularisation as the endpoint.
Five studies were identified including a total of 5460 patients eligible for meta-analyses. The primary endpoint occurred in 60 (1.1%) patients, 0.6% (13/2126) with FFR>0.80% and 1.4% (47/3334) with FFR ≤0.80 (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005). Likewise, MACE, MI, spontaneous MI or unplanned revascularisation occurred more frequently in patients with FFR ≤0.80 versus patients with FFR >0.80. Each 0.10-unit FFR reduction was associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001).
The 12-month outcomes in patients with stable CAD show low rates of events in those with a negative FFR result, and lower risk of an unfavourable outcome in patients with a negative test result compared with patients with a positive test result. Moreover, the FFR numerical value was inversely associated with outcomes.
为了更全面地评估血流储备分数检测的预后价值，我们对 2010 年 1 月 1 日至 2020 年 12 月 31 日期间发表的评估 CT 衍生血流储备分数（FFR）（HeartFlow）分析在稳定型冠状动脉疾病（CAD）患者中临床结局的研究进行了系统文献回顾和协作荟萃分析。
我们在 PubMed 和 Web of Science 电子数据库中检索了评估 2010 年 1 月 1 日至 2020 年 12 月 31 日期间血流储备分数检测后 12 个月临床结局的已发表研究。主要终点定义为 12 个月随访时的“全因死亡率（ACM）或心肌梗死（MI）”。使用主要不良心血管事件（MACEs，ACM+MI+计划外血运重建）、ACM、MI、自发性 MI 或计划外（>3 个月）血运重建作为终点进行探索性分析。
共确定了 5 项研究，共纳入 5460 名符合荟萃分析条件的患者。主要终点在 60 名（1.1%）患者中发生，FFR>0.80%的患者中为 0.6%（13/2126），FFR ≤0.80%的患者中为 1.4%（47/3334）（相对风险（RR）2.31（95% CI 1.29 至 4.13），p=0.005）。同样，FFR ≤0.80 的患者与 FFR>0.80 的患者相比，更频繁发生 MACE、MI、自发性 MI 或计划外血运重建。FFR 每降低 0.10 单位，主要终点的风险增加（RR 1.67（95% CI 1.47 至 1.87），p<0.001）。
稳定型 CAD 患者的 12 个月结局显示阴性 FFR 结果患者的事件发生率较低，与阳性 FFR 结果患者相比，阴性 FFR 结果患者不良结局风险较低。此外，FFR 数值与结局呈负相关。
