单独的血流储备分数与血管造影指导心肌血运重建术的比较：随机试验的系统评价和荟萃分析。

Fractional flow reserve versus angiography alone in guiding myocardial revascularisation: a systematic review and meta-analysis of randomised trials.

机构信息

Cardiology, Baylor College of Medicine, Houston, Texas, USA.

Internal Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.

出版信息

Heart. 2022 Oct 13;108(21):1699-1706. doi: 10.1136/heartjnl-2021-320768.

DOI:10.1136/heartjnl-2021-320768

PMID:35568392

Abstract

BACKGROUND

Randomised trials evaluating the efficacy and safety of fractional flow reserve (FFR)-guided versus angiography-guided revascularisation among patients with obstructive coronary artery disease (CAD) have yielded mixed results.

AIMS

To examine the comparative efficacy and safety of FFR-guided versus angiography-guided revascularisation among patients with obstructive CAD.

METHODS

An electronic search of MEDLINE, SCOPUS and Cochrane databases without language restrictions was performed through November 2021 for randomised controlled trials that evaluated the outcomes of FFR-guided versus angiography-guided revascularisation. The primary outcome was major adverse cardiac events (MACE). Data were pooled using a random-effects model.

RESULTS

The final analysis included seven trials with 5094 patients. The weighted mean follow-up duration was 38 months. Compared with angiography guidance, FFR guidance was associated with fewer number of stents during revascularisation (standardised mean difference=-0.80; 95% CI -1.33 to -0.27), but no difference in total hospital cost. There was no difference between FFR-guided and angiography-guided revascularisation in long-term MACE (13.6% vs 13.9%; risk ratio (RR) 0.97, 95% CI 0.85 to 1.11). Meta-regression analyses did not reveal any evidence of effect modification for MACE with acute coronary syndrome (p=0.36), proportion of three-vessel disease (p=0.88) or left main disease (p=0.50). There were no differences between FFR-guided and angiography-guided revascularisation in the outcomes all-cause mortality (RR 1.16, 95% CI 0.80 to 1.68), cardiovascular mortality (RR 1.27, 95% CI 0.50 to 3.26), repeat revascularisation (RR 0.99, 95% CI 0.81 to 1.21), recurrent myocardial infarction (RR 0.92, 95% CI 0.74 to 1.14) or stent thrombosis (RR 0.61, 95% CI 0.31 to 1.21).

CONCLUSION

Among patients with obstructive CAD, FFR-guided revascularisation did not reduce the risk of long-term adverse cardiac events or the individual outcomes. However, FFR-guided revascularisation was associated with fewer number of stents.

PROSPERO REGISTRATION NUMBER

CRD42021291596.

摘要

背景

评估在有阻塞性冠状动脉疾病（CAD）的患者中，使用血流储备分数（FFR）指导与血管造影指导血运重建的疗效和安全性的随机试验结果不一。

目的

检查 FFR 指导与血管造影指导血运重建在有阻塞性 CAD 患者中的比较疗效和安全性。

方法

通过电子检索 MEDLINE、SCOPUS 和 Cochrane 数据库，未设语言限制，检索时间截至 2021 年 11 月，纳入评估 FFR 指导与血管造影指导血运重建结局的随机对照试验。主要结局为主要不良心脏事件（MACE）。使用随机效应模型对数据进行合并。

结果

最终分析纳入了 7 项试验共 5094 例患者。加权平均随访时间为 38 个月。与血管造影指导相比，FFR 指导的血运重建过程中支架数量更少（标准化均数差=-0.80；95%CI-1.33 至-0.27），但总住院费用无差异。FFR 指导与血管造影指导的血运重建在长期 MACE 方面无差异（13.6%比 13.9%；风险比（RR）0.97，95%CI0.85 至 1.11）。元回归分析未发现 MACE 与急性冠状动脉综合征（p=0.36）、三血管病变比例（p=0.88）或左主干疾病（p=0.50）之间存在任何效应修饰的证据。FFR 指导与血管造影指导的血运重建在全因死亡率（RR1.16，95%CI0.80 至 1.68）、心血管死亡率（RR1.27，95%CI0.50 至 3.26）、再次血运重建（RR0.99，95%CI0.81 至 1.21）、复发性心肌梗死（RR0.92，95%CI0.74 至 1.14）或支架血栓形成（RR0.61，95%CI0.31 至 1.21）方面无差异。