冠状动脉血运重建中血流储备分数的应用：一项系统评价和荟萃分析。
Fractional flow reserve use in coronary artery revascularization: A systematic review and meta-analysis.
作者信息
Sanz Sánchez Jorge, Farjat Pasos Julio I, Martinez Solé Julia, Hussain Bilal, Kumar Sant, Garg Mohil, Chiarito Mauro, Teira Calderón Andrea, Sorolla-Romero Jose A, Echavarria Pinto Mauro, Shin Eun-Seok, Diez Gil José Luis, Waksman Ron, van de Hoef Tim P, Garcia-Garcia Hector M
机构信息
Hospital Universitari i Politecnic La Fe, Valencia, Spain.
Centro de Investigación Biomedica en Red (CIBERCV), Madrid, Spain.
出版信息
iScience. 2023 Jul 3;26(8):107245. doi: 10.1016/j.isci.2023.107245. eCollection 2023 Aug 18.
Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is recommended in revascularization guidelines for intermediate lesions. However, recent studies comparing FFR-guided PCI with non-physiology-guided revascularization have reported conflicting results. PubMed and Embase were searched for studies comparing FFR-guided PCI with non-physiology-guided revascularization strategies (angiography-guided, intracoronary imaging-guided, coronary artery bypass grafting). Data were pooled by meta-analysis using random-effects model. 26 studies enrolling 78,897 patients were included. FFR-guided PCI as compared to non-physiology-guided coronary revascularization had lower risk of all-cause mortality (odds ratio [OR] 0.79 95% confidence interval [CI] 0.64-0.99, I = 53%) and myocardial infarction (MI) (OR 0.74 95% CI 0.59-0.93, I = 44.7%). However, no differences between groups were found in terms of major adverse cardiac events (MACEs) (OR 0.86 95% CI 0.72-1.03, I = 72.3%) and repeat revascularization (OR 1 95% CI 0.82-1.20, I = 43.2%). Among patients with coronary artery disease (CAD), FFR-guided PCI as compared to non-physiology-guided revascularization was associated with a lower risk of all-cause mortality and MI.
对于中等病变的血运重建指南，推荐采用基于血流储备分数（FFR）指导的经皮冠状动脉介入治疗（PCI）。然而，最近比较FFR指导的PCI与非生理学指导的血运重建的研究报告了相互矛盾的结果。检索了PubMed和Embase数据库，以查找比较FFR指导的PCI与非生理学指导的血运重建策略（血管造影指导、冠状动脉内成像指导、冠状动脉旁路移植术）的研究。使用随机效应模型通过荟萃分析汇总数据。纳入了26项研究，共78897例患者。与非生理学指导的冠状动脉血运重建相比，FFR指导的PCI全因死亡率风险较低（比值比[OR]0.79，95%置信区间[CI]0.64 - 0.99，I² = 53%）和心肌梗死（MI）风险较低（OR 0.74，95%CI 0.59 - 0.93，I² = 44.7%）。然而，在主要不良心脏事件（MACE）方面（OR 0.86，95%CI 0.72 - 1.03，I² = 72.3%）和再次血运重建方面（OR 1，95%CI 0.82 - 1.20，I² = 43.2%），两组之间未发现差异。在冠状动脉疾病（CAD）患者中，与非生理学指导的血运重建相比，FFR指导的PCI全因死亡率和MI风险较低。
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