Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital, Seoul National University College of Medicine Seoul South Korea.
Department of Cardiology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China.
J Am Heart Assoc. 2023 Sep 5;12(17):e030572. doi: 10.1161/JAHA.123.030572. Epub 2023 Aug 29.
Background Cardiac death or myocardial infarction still occurs in patients undergoing contemporary percutaneous coronary intervention (PCI). We aimed to identify adverse clinical and vessel characteristics related to hard outcomes after PCI and to investigate their individual and combined prognostic implications. Methods and Results From an individual patient data meta-analysis of 17 cohorts of patients who underwent post-PCI fractional flow reserve measurement after drug-eluting stent implantation, 2081 patients with available clinical and vessel characteristics were analyzed. The primary outcome was cardiac death or target-vessel myocardial infarction at 2 years. The mean age of patients was 64.2±10.2 years, and the mean angiographic percent diameter stenosis was 63.9%±14.3%. Among 11 clinical and 8 vessel features, 4 adverse clinical characteristics (age ≥65 years, diabetes, chronic kidney disease, and left ventricular ejection fraction <50%) and 2 adverse vessel characteristics (post-PCI fractional flow reserve ≤0.80 and total stent length ≥54 mm) were identified to independently predict the primary outcome (all <0.05). The number of adverse vessel characteristics had additive predictability for the primary end point to that of adverse clinical characteristics (area under the curve 0.72 versus 0.78; =0.03) and vice versa (area under the curve 0.68 versus 0.78; =0.03). The cumulative event rate increased in the order of none, either, and both of adverse clinical characteristics ≥2 and adverse vessel characteristics ≥1 (0.3%, 2.4%, and 5.3%; for trend <0.01). Conclusions In patients undergoing drug-eluting stent implantation, adverse clinical and vessel characteristics were associated with the risk of cardiac death or target-vessel myocardial infarction. Because these characteristics showed independent and additive prognostic value, their integrative assessment can optimize post-PCI risk stratification. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04684043. www.crd.york.ac.uk/prospero/. Unique Identifier: CRD42021234748.
在接受当代经皮冠状动脉介入治疗（PCI）的患者中，仍会发生心源性死亡或心肌梗死。我们旨在确定与 PCI 后不良临床和血管特征相关的硬终点，并研究其个体和联合预后意义。
对接受药物洗脱支架植入术后行 PCI 后血流储备分数测量的 17 个患者队列的个体患者数据进行荟萃分析，对 2081 名具有可用临床和血管特征的患者进行了分析。主要结局是 2 年内心源性死亡或靶血管心肌梗死。患者的平均年龄为 64.2±10.2 岁，平均血管造影狭窄程度为 63.9%±14.3%。在 11 个临床特征和 8 个血管特征中，4 个不良临床特征（年龄≥65 岁、糖尿病、慢性肾脏病和左心室射血分数<50%）和 2 个不良血管特征（PCI 后血流储备分数≤0.80 和总支架长度≥54mm）被确定为独立预测主要结局的因素（均<0.05）。不良血管特征的数量对主要终点的预测能力与不良临床特征相当（曲线下面积 0.72 对 0.78；=0.03），反之亦然（曲线下面积 0.68 对 0.78；=0.03）。无、一种或两种不良临床特征≥2 和一种或两种不良血管特征≥1 的累积事件发生率依次升高（0.3%、2.4%和 5.3%；趋势检验<0.01）。
在接受药物洗脱支架植入的患者中，不良的临床和血管特征与心源性死亡或靶血管心肌梗死的风险相关。由于这些特征显示出独立且附加的预后价值，因此整合评估可以优化 PCI 后的风险分层。
https://www.clinicaltrials.gov；唯一标识符：NCT04684043。www.crd.york.ac.uk/prospero/；唯一标识符：CRD42021234748。
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