Benseba Juva, Mercier Julien, Couture Thomas, Faroux Laurent, Bernatchez Laurence, Côté Mélanie, Panagides Vassili, Mesnier Jules, Mohammadi Siamak, Dumont Éric, Kalavrouziotis Dimitri, Hadjadj Sandra, Beaudoin Jonathan, DeLarochellière Robert, Rodés-Cabau Josep, Paradis Jean-Michel
Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada.
Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Canada.
Struct Heart. 2023 Apr 18;7(4):100179. doi: 10.1016/j.shj.2023.100179. eCollection 2023 Jul.
The long-term outcomes of patients undergoing functional assessment of coronary lesions with fractional flow reserve (FFR) while awaiting transcatheter aortic valve implantation (TAVI) are unknown. Data on the safety of intracoronary adenosine use in this setting are scarce. The objectives of this study were to describe (1) the long-term outcomes based on the coronary artery disease (CAD) assessment strategy used and (2) the safety of intracoronary adenosine in patients with severe aortic stenosis (AS).
1023 patients with severe AS awaiting TAVI were included. Patients were classified according to their CAD assessment strategy: angiography guided or FFR guided. Patients were further subdivided according to the decision to proceed with percutaneous coronary intervention (PCI): angiography-guided PCI (375/1023), angiography-guided no-PCI (549/1023), FFR-guided PCI (50/1023), and FFR-guided no-PCI (49/1023). Patients were followed up for the occurrence of major adverse cardiac and cerebrovascular events (MACCEs).
At a mean follow-up of 33.7 months, we observed no significant differences in terms of major adverse cardiovascular and cerebrovascular events (MACCE) in the angiography-guided group (42.4%) compared with the FFR-guided group (37.4%) ( = 0.333). When comparing outcomes of the FFR-guided no-PCI group (32.7%) with the angiography-guided PCI group (46.4%), no significant difference was noted ( = 0.999). Following intracoronary adenosine, a single adverse event occurred.
In this population, intracoronary adenosine is safe and well tolerated. We found no significant benefit to an FFR-guided strategy compared with an angiography-guided strategy with respect to MACCEs. Although clinically compelling, avoiding the procedural risks of PCI by deferring the intervention in functionally insignificant lesions failed to show a statistically significant benefit.
在等待经导管主动脉瓣植入术（TAVI）期间接受冠状动脉病变血流储备分数（FFR）功能评估的患者的长期预后尚不清楚。关于在此情况下使用冠状动脉内腺苷的安全性的数据很少。本研究的目的是描述（1）基于所使用的冠状动脉疾病（CAD）评估策略的长期预后，以及（2）严重主动脉瓣狭窄（AS）患者冠状动脉内腺苷的安全性。
纳入1023例等待TAVI的严重AS患者。根据其CAD评估策略对患者进行分类：血管造影引导或FFR引导。根据是否进行经皮冠状动脉介入治疗（PCI）的决定，患者进一步细分：血管造影引导下PCI（375/1023）、血管造影引导下不进行PCI（549/1023）、FFR引导下PCI（50/1023）和FFR引导下不进行PCI（49/1023）。对患者进行随访，观察主要不良心脑血管事件（MACCE）的发生情况。
平均随访33.7个月时，我们观察到血管造影引导组（42.4%）与FFR引导组（37.4%）相比，主要不良心脑血管事件（MACCE）无显著差异（P = 0.333）。比较FFR引导下不进行PCI组（32.7%）与血管造影引导下PCI组（46.4%）的结果，未发现显著差异（P = 0.999）。冠状动脉内注射腺苷后，发生了1例不良事件。
在该人群中，冠状动脉内腺苷是安全且耐受性良好的。我们发现，与血管造影引导策略相比，FFR引导策略在MACCE方面没有显著益处。尽管在临床上有说服力，但通过推迟对功能上无意义病变的干预来避免PCI的手术风险并未显示出统计学上的显著益处。
