Terentes-Printzios Dimitrios, Gkini Konstantia-Paraskevi, Oikonomou Dimitrios, Gardikioti Vasiliki, Aznaouridis Konstantinos, Dima Ioanna, Tsioufis Konstantinos, Vlachopoulos Charalambos
First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, 114 Vasilissis Sofias St., 11527 Athens, Greece.
J Pers Med. 2023 Aug 12;13(8):1251. doi: 10.3390/jpm13081251.
The post-percutaneous coronary intervention (post-PCI) fractional flow reserve (FFR) can detect suboptimal PCI or residual ischemia and potentially lead to fewer adverse clinical outcomes. We sought to investigate the predictive value of the angiography-derived FFR for adverse cardiovascular events in patients after PCI. We conducted a comprehensive search of electronic databases, MEDLINE, EMBASE, and the Cochrane Library, for studies published until March 2023 that investigated the prognostic role of angiography-derived fractional flow reserve values after PCI. We investigated the best predictive ability of the post-PCI angiography-derived FFR and relative risk (RR) estimates with 95% confidence intervals (CIs) between post-PCI angiography-derived FFR values and adverse events. Thirteen cohort studies involving 6961 patients (9719 vascular lesions; mean follow-up: 2.2 years) were included in this meta-analysis. The pooled HR of the studies using specific cut-off points for post-PCI angiography-derived FFR was 4.13 (95% CI, 2.92-5.82) for total cardiovascular events, while the pooled HRs for target vessel revascularization, cardiac death, target vessel myocardial infarction, and target lesion revascularization were 6.87 (95% CI, 4.93-9.56), 6.17 (95% CI, 3.52-10.80), 3.98 (95% CI, 2.37-6.66) and 6.27 (95% CI, 3.08-12.79), respectively. In a sensitivity analysis of three studies with 1789 patients assessing the predictive role of the post-PCI angiography-derived FFR as a continuous variable, we found a 58% risk reduction for future adverse events per 0.1 increase in the post-PCI angiography-derived FFR value. In conclusion, post-PCI angiography-derived FFR is an effective tool for predicting adverse cardiovascular events and could be potentially used in decision making, both during PCI and in the long-term follow-up.
经皮冠状动脉介入治疗（PCI）后血流储备分数（FFR）可检测出PCI效果欠佳或残余缺血情况，并可能减少不良临床结局。我们旨在研究血管造影衍生的FFR对PCI术后患者不良心血管事件的预测价值。我们全面检索了电子数据库MEDLINE、EMBASE和Cochrane图书馆，以查找截至2023年3月发表的研究PCI术后血管造影衍生的FFR值预后作用的研究。我们研究了PCI术后血管造影衍生的FFR的最佳预测能力以及PCI术后血管造影衍生的FFR值与不良事件之间具有95%置信区间（CI）的相对风险（RR）估计值。这项荟萃分析纳入了13项队列研究，涉及6961例患者（9719处血管病变；平均随访时间：2.2年）。对于全因心血管事件，使用PCI术后血管造影衍生的FFR特定截断点的研究汇总风险比（HR）为4.13（95%CI，2.92 - 5.82），而靶血管血运重建、心源性死亡、靶血管心肌梗死和靶病变血运重建的汇总HR分别为6.87（95%CI，4.93 - 9.56）、6.17（95%CI，3.52 - 10.80）、3.98（95%CI，2.37 - 6.66）和6.27（95%CI，3.08 - 12.79）。在一项对1789例患者的三项研究进行的敏感性分析中，评估PCI术后血管造影衍生的FFR作为连续变量的预测作用，我们发现PCI术后血管造影衍生的FFR值每增加0.1，未来不良事件风险降低58%。总之，PCI术后血管造影衍生的FFR是预测不良心血管事件的有效工具，在PCI期间及长期随访中都可能用于决策制定。
