冠心病患者不同亚组人群中血流储备分数的预后评估。
Prognostic Assessment of Fractional Flow Reserve in Different Strata in Patients with Coronary Artery Disease.
机构信息
Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS - Brasil.
Hospital São Lucas da PUCRS, Porto Alegre, RS - Brasil.
出版信息
Arq Bras Cardiol. 2023 May;120(6):e20211051. doi: 10.36660/abc.20211051.
BACKGROUND
There are limited real-world data on the clinical course of untreated coronary lesions according to their functional severity.
OBJECTIVE
To evaluate the 5-year clinical outcomes of patients with revascularized lesions with fractional flow reserve (FFR) ≤ 0.8 and patients with non-revascularized lesions with FFR > 0.8.
METHODS
The FFR assessment was performed in 218 patients followed for up to 5 years. Participants were classified based on FFR into ischemia group (≤ 0.8, intervention group, n = 55), low-normal FFR group (> 0.8-0.9, n = 91), and high-normal FFR group (> 0.9, n = 72). The primary endpoint was major adverse cardiac events (MACEs), a composite of death, myocardial infarction, and need for repeat revascularization. The significance level was set at 0.05; therefore, results with a p-value < 0.05 were considered statistically significant.
RESULTS
Most patients were male (62.8%) with a mean age of 64.1 years. Diabetes was present in 27%. On coronary angiography, the severity of stenosis was 62% in the ischemia group, 56.4% in the low-normal FFR group, and 54.3% in the high-normal FFR group (p<0.05). Mean follow-up was 3.5 years. The incidence of MACEs was 25.5%, 13.2%, and 11.1%, respectively (p=0.037). MACE incidence did not differ significantly between the low-normal and high-normal FFR groups.
CONCLUSION
Patients with FFR indicative of ischemia had poorer outcomes than those in non-ischemia groups. There was no difference in the incidence of events between the low-normal and high-normal FFR groups. Long-term studies with a large sample size are needed to better assess cardiovascular outcomes in patients with moderate coronary stenosis with FFR values between 0.8 and 1.0.
背景
根据功能性严重程度，未经治疗的冠状动脉病变的临床过程的真实世界数据有限。
目的
评估经血管重建的 FFR≤0.8 病变患者和未进行血运重建的 FFR>0.8 病变患者的 5 年临床结局。
方法
对 218 例患者进行了 FFR 评估，随访时间长达 5 年。根据 FFR 将患者分为缺血组（≤0.8，干预组，n=55）、低正常 FFR 组（>0.8-0.9，n=91）和高正常 FFR 组（>0.9，n=72）。主要终点是主要不良心脏事件（MACEs），包括死亡、心肌梗死和再次血运重建的需要。显著性水平设定为 0.05；因此，p 值<0.05 的结果被认为具有统计学意义。
结果
大多数患者为男性（62.8%），平均年龄 64.1 岁。27%的患者患有糖尿病。在冠状动脉造影中，缺血组的狭窄严重程度为 62%，低正常 FFR 组为 56.4%，高正常 FFR 组为 54.3%（p<0.05）。平均随访时间为 3.5 年。MACE 的发生率分别为 25.5%、13.2%和 11.1%（p=0.037）。低正常和高正常 FFR 组之间的 MACE 发生率无显著差异。
结论
FFR 提示缺血的患者结局较非缺血组差。低正常和高正常 FFR 组之间的事件发生率无差异。需要进行长期、大样本量的研究，以更好地评估 FFR 值在 0.8 至 1.0 之间的中度冠状动脉狭窄患者的心血管结局。
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