使用增强现实技术对残余定量血流分数进行术前模拟预测 PCI 术后结果。
Post-PCI outcomes predicted by pre-intervention simulation of residual quantitative flow ratio using augmented reality.
机构信息
State Key Laboratory of Cardiovascular Disease, Beijing, China; Cardiometabolic Medicine Center, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
出版信息
Int J Cardiol. 2022 Apr 1;352:33-39. doi: 10.1016/j.ijcard.2022.01.054. Epub 2022 Jan 31.
BACKGROUND
The simulated residual quantitative flow ratio (QFR) computed from pre-intervention three-dimensional (3-D) coronary angiograms, which could theoretically predict actual post-percutaneous coronary intervention (PCI) QFR value, can be used for enhanced PCI via augmented reality. The study sought to investigate the concordance between simulated residual QFR and actual post-PCI QFR, and the prognostic value of simulated residual QFR.
METHODS
QFR assessment was retrospectively performed in treated vessels from the all-comers PANDA III trial. Three-step analysis was performed: 1) concordance between simulated residual QFR and post-PCI QFR; 2) prognostic value of simulated residual QFR; and 3) forecast of outcomes by virtual randomized controlled trials (RCTs) between residual QFR and angiographic guidance.
RESULTS
Of 2989 treated vessels, 2146 (71.8%) with paired analyzable simulated residual QFR and post-PCI QFR were included. The simulated residual QFR and post-PCI QFR were strongly correlated (r = 0.976). Low simulated residual QFR (≤0.92) was independently associated with higher risk of 2-year vessel-oriented composite endpoint (adjusted hazard ratio: 5.50; 95% confidence interval: 3.03 to 10.0). Based upon 5000 iterations of virtual RCTs, simulated residual QFR-guided strategy was anticipated to have a 2.6% absolute reduction of 2-year incidence of target vessel failure compared with the angiography-guided strategy.
CONCLUSIONS
With high consistency to actual post-PCI QFR, the simulated residual QFR computed from pre-PCI 3-D coronary angiograms and augmented reality could predict functional outcome of the procedure and 2-year prognosis. Using data from PANDA III trial, the present study forecasted superiority of residual QFR-guided PCI strategy over angiographic guidance. Clinical Trial Registration Information URL: https://www.clinicaltrials.gov; Unique identifier: NCT02017275.
背景
从术前三维（3-D）冠状动脉造影计算得出的模拟残余定量血流比（QFR）理论上可以预测实际经皮冠状动脉介入治疗（PCI）后的 QFR 值，可用于增强现实辅助的 PCI。本研究旨在探讨模拟残余 QFR 与实际 PCI 后 QFR 的一致性，以及模拟残余 QFR 的预后价值。
方法
对所有入组的 PANDA III 试验中的治疗血管进行 QFR 评估。进行了三步分析：1）模拟残余 QFR 与 PCI 后 QFR 的一致性；2）模拟残余 QFR 的预后价值；3）模拟残余 QFR 与血管造影指导的虚拟随机对照试验（RCT）之间的结果预测。
结果
在 2989 个治疗血管中，有 2146 个（71.8%）具有可分析的配对模拟残余 QFR 和 PCI 后 QFR，纳入分析。模拟残余 QFR 和 PCI 后 QFR 呈高度相关（r=0.976）。低模拟残余 QFR（≤0.92）与 2 年血管导向复合终点风险增加独立相关（调整后的危险比：5.50；95%置信区间：3.03 至 10.0）。基于 5000 次虚拟 RCT 迭代，预计模拟残余 QFR 指导策略与血管造影指导策略相比，2 年靶血管失败发生率将降低 2.6%。
结论
模拟残余 QFR 与实际 PCI 后 QFR 具有高度一致性，从术前 3-D 冠状动脉造影和增强现实计算得出的 QFR 可以预测手术的功能结果和 2 年预后。利用 PANDA III 试验的数据，本研究预测了残余 QFR 指导的 PCI 策略优于血管造影指导。临床试验注册信息 URL：https://www.clinicaltrials.gov；唯一标识符：NCT02017275。
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