经皮冠状动脉介入术后生理评估的安全性和有效性：来自使用血流储备分数的中间病变血运重建优化和生理评估登记处的回顾性数据。
Safety and effectiveness of post percutaneous coronary intervention physiological assessment: Retrospective data from the post-revascularization optimization and physiological evaluation of intermediate lesions using fractional flow reserve registry.
作者信息
Leone Antonio Maria, Migliaro Stefano, Zimbardo Giuseppe, Cialdella Pio, Basile Eloisa, Galante Domenico, Di Giusto Federico, Anastasia Gianluca, Vicere Andrea, Petrolati Edoardo, Di Stefano Antonio, Campaniello Giorgia, D'Amario Domenico, Vergallo Rocco, Montone Rocco Antonio, Buffon Antonino, Romagnoli Enrico, Aurigemma Cristina, Burzotta Francesco, Trani Carlo, Crea Filippo
机构信息
Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy.
Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy.
出版信息
Front Cardiovasc Med. 2022 Aug 18;9:983003. doi: 10.3389/fcvm.2022.983003. eCollection 2022.
BACKGROUND
While the importance of invasive physiological assessment (IPA) to choose coronary lesions to be treated is ascertained, its role after PCI is less established. We evaluated feasibility and efficacy of Physiology-guided PCI in the everyday practice in a retrospective registry performed in a single high-volume and "physiology-believer" center.
MATERIALS AND METHODS
The PROPHET-FFR study (NCT05056662) patients undergoing an IPA in 2015-2020 were retrospectively enrolled in three groups: Control group comprising patients for whom PCI was deferred based on a IPA; Angiography-Guided PCI group comprising patients undergoing PCI based on an IPA but without a post-PCI IPA; Physiology-guided PCI group comprising patients undergoing PCI based on an IPA and an IPA after PCI, followed by a physiology-guided optimization, if indicated. Optimal result was defined by an FFR value ≥ 0.90.
RESULTS
A total of 1,322 patients with 1,591 lesions were available for the analysis. 893 patients (67.5%) in Control Group, 249 patients (18.8%) in Angiography-guided PCI Group and 180 patients (13.6%) in Physiology-guided PCI group. In 89 patients a suboptimal functional result was achieved that was optimized in 22 cases leading to a "Final FFR" value of 0.90 ± 0.04 in Angiography-Guided PCI group. Procedural time, costs, and rate of complications were similar. At follow up the rate of MACEs for the Physiology-guided PCI group was similar to the Control Group (7.2% vs. 8.2%, = 0.765) and significantly lower than the Angiography-guided PCI Group (14.9%, < 0.001), mainly driven by a reduction in TVRs.
CONCLUSION
"Physiology-guided PCI" is a feasible strategy with a favorable impact on mid-term prognosis. Prospective studies using a standardized IPA are warrant to confirm these data.
背景
虽然有创生理评估（IPA）对于选择待治疗的冠状动脉病变的重要性已得到确定，但其在经皮冠状动脉介入治疗（PCI）后的作用尚不明确。我们在一个高容量且“相信生理学评估”的单一中心进行的回顾性登记研究中，评估了生理学指导下的PCI在日常临床实践中的可行性和疗效。
材料与方法
PROPHET-FFR研究（NCT05056662）纳入了2015年至2020年期间接受IPA的患者，并将其回顾性分为三组：对照组，包括基于IPA而推迟PCI的患者；血管造影指导下的PCI组，包括基于IPA接受PCI但术后未进行IPA的患者；生理学指导下的PCI组，包括基于IPA接受PCI且术后进行IPA的患者，如有必要，随后进行生理学指导下的优化。最佳结果定义为血流储备分数（FFR）值≥0.90。
结果
共有1322例患者的1591处病变可供分析。对照组893例患者（67.5%），血管造影指导下的PCI组249例患者（18.8%），生理学指导下的PCI组180例患者（13.6%）。在89例患者中获得了次优的功能结果，其中22例得到优化，使得血管造影指导下的PCI组的“最终FFR”值为0.90±0.04。手术时间、费用和并发症发生率相似。随访时，生理学指导下的PCI组的主要不良心血管事件（MACE）发生率与对照组相似（7.2%对8.2%，P = 0.765），且显著低于血管造影指导下的PCI组（14.9%，P < 0.001），主要是由于靶病变血运重建（TVR）减少所致。
结论
“生理学指导下的PCI”是一种可行的策略，对中期预后有积极影响。需要进行使用标准化IPA的前瞻性研究来证实这些数据。
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