Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.S., G.S.M., M.M., Z.A.A., M.L., A.J., O.B.-Y., A.M.).
NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY (F.S., A.M.).
Circ Cardiovasc Interv. 2022 Nov;15(11):851-860. doi: 10.1161/CIRCINTERVENTIONS.121.011198. Epub 2022 Nov 15.
Hemodynamic assessment of untreated nonculprit lesions was not studied in the PROSPECT study (Providing Regional Observations to Study Predictors of Events in the Coronary Tree). We developed a virtual intravascular ultrasound-derived lesion-specific fractional flow reserve (lesion-specific IVUS-FFR) algorithm to assess individual lesion-level FFR. We sought to investigate the relation between lesion-specific IVUS-FFR and major adverse cardiovascular events (MACE) arising from untreated nonculprit lesions in the PROSPECT study.
In PROSPECT, 697 patients with acute coronary syndromes underwent 3-vessel grayscale and virtual histology-IVUS to correlate untreated nonculprit plaque morphology with 3-year nonculprit related MACE (composite of cardiac death, cardiac arrest, myocardial infarction, or rehospitalization due to unstable or progressive angina). Lesion-specific IVUS-FFR was calculated from volumetric IVUS lumen area measurements at 0.4 mm intervals by applying a mathematical circulation model using basic fluid dynamics equations.
Lesion-specific IVUS-FFR was analyzable in 3227 nonculprit lesions in 660 patients among whom 54 nonculprit MACE events (3 myocardial infarctions) occurred at median 3.4-year follow-up. By receiver-operating characteristic analysis, the best cutoff value of lesion-specific IVUS-FFR to predict nonculprit MACE was ≤0.95. After adjusting for patient and lesion characteristics, lesion-specific IVUS-FFR (hazard ratio, 4.83 [95% CI, 2.20-10.61]; <0.001) was an independent predictor of 3-year nonculprit MACE, in addition to minimum lumen area≤4.0 mm, plaque burden ≥70%, and virtual histology thin-cap fibroatheroma.
Minor reductions in lesion-specific IVUS-FFR were independently associated with future nonculprit MACE arising from untreated angiographically mild stenoses along with previously established high-risk lesion morphological characteristics.
URL: https://www.
gov; Unique identifier: NCT00180466.
在 PROSPECT 研究（提供冠状动脉树事件预测因素的区域观察）中，未研究未经治疗的非罪犯病变的血流动力学评估。我们开发了一种虚拟血管内超声衍生的病变特异性血流储备分数（病变特异性 IVUS-FFR）算法来评估个体病变水平的 FFR。我们试图研究 PROSPECT 研究中未经治疗的非罪犯病变的病变特异性 IVUS-FFR 与主要不良心血管事件（MACE）之间的关系。
在 PROSPECT 中，697 例急性冠脉综合征患者接受了 3 支血管灰阶和虚拟组织学-IVUS 检查，以将未经治疗的非罪犯斑块形态与 3 年非罪犯相关的 MACE（心脏死亡、心脏骤停、心肌梗死或因不稳定或进行性心绞痛再次住院的复合终点）相关联。病变特异性 IVUS-FFR 通过在 0.4mm 间隔处应用体积 IVUS 管腔面积测量值，应用基本流体动力学方程的数学循环模型计算得出。
在 660 例患者的 3227 个非罪犯病变中，可对病变特异性 IVUS-FFR 进行分析，其中 54 个非罪犯 MACE 事件（3 例心肌梗死）在中位 3.4 年随访时发生。通过接收者操作特征分析，预测非罪犯 MACE 的病变特异性 IVUS-FFR 的最佳截断值为≤0.95。在校正患者和病变特征后，病变特异性 IVUS-FFR（危险比，4.83 [95%置信区间，2.20-10.61]；<0.001）是 3 年非罪犯 MACE 的独立预测因子，除了最小管腔面积≤4.0mm、斑块负荷≥70%和虚拟组织学薄帽纤维粥样斑块外。
病变特异性 IVUS-FFR 的轻微降低与以前建立的高危病变形态特征一起，与未经治疗的血管造影轻度狭窄的未来非罪犯 MACE 独立相关。
