左心室功能障碍对冠状动脉支架植入术后测量的血流储备分数的不同影响。
Differential Impact of Fractional Flow Reserve Measured After Coronary Stent Implantation by Left Ventricular Dysfunction.
作者信息
Choi Ki Hong, Kwon Woochan, Shin Doosup, Lee Seung-Hun, Hwang Doyeon, Zhang Jinlong, Nam Chang-Wook, Shin Eun-Seok, Doh Joon-Hyung, Chen Shao-Liang, Kakuta Tsunekazu, Toth Gabor G, Piroth Zsolt, Hakeem Abdul, Uretsky Barry F, Hokama Yohei, Tanaka Nobuhiro, Lim Hong-Seok, Ito Tsuyoshi, Matsuo Akiko, Azzalini Lorenzo, Leesar Massoud A, Daemen Joost, Collison Damien, Collet Carlos, De Bruyne Bernard, Koo Bon-Kwon, Park Taek Kyu, Yang Jeong Hoon, Song Young Bin, Hahn Joo-Yong, Choi Seung-Hyuk, Gwon Hyeon-Cheol, Lee Joo Myung
机构信息
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina, USA.
出版信息
JACC Asia. 2023 Dec 12;4(3):229-240. doi: 10.1016/j.jacasi.2023.10.009. eCollection 2024 Mar.
BACKGROUND
Both left ventricular systolic function and fractional flow reserve (FFR) are prognostic factors after percutaneous coronary intervention (PCI). However, how these prognostic factors are inter-related in risk stratification of patients after PCI remains unclarified.
OBJECTIVES
This study evaluated differential prognostic implication of post-PCI FFR according to left ventricular ejection fraction (LVEF).
METHODS
A total of 2,965 patients with available LVEF were selected from the POST-PCI FLOW (Prognostic Implications of Physiologic Investigation After Revascularization with Stent) international registry of patients with post-PCI FFR measurement. The primary outcome was a composite of cardiac death or target-vessel myocardial infarction (TVMI) at 2 years. The secondary outcome was target-vessel revascularization (TVR) and target vessel failure, which was a composite of cardiac death, TVMI, or TVR.
RESULTS
Post-PCI FFR was independently associated with the risk of target vessel failure (per 0.01 decrease: HR: 1.029; 95% CI: 1.009-1.049; 0.005). Post-PCI FFR was associated with increased risk of cardiac death or TVMI (HR: 1.145; 95% CI: 1.025-1.280; 0.017) among patients with LVEF ≤40%, and with that of TVR in patients with LVEF >40% (HR: 1.028; 95% CI: 1.005-1.052; 0.020). Post-PCI FFR ≤0.80 was associated with increased risk of cardiac death or TVMI in the LVEF ≤40% group and with that of TVR in LVEF >40% group. Prognostic impact of post-PCI FFR for the primary outcome was significantly different according to LVEF ( = 0.019).
CONCLUSIONS
Post-PCI FFR had differential prognostic impact according to LVEF. Residual ischemia by post-PCI FFR ≤0.80 was a prognostic indicator for cardiac death or TVMI among patients with patients with LVEF ≤40%, and it was associated with TVR among patients with patients with LVEF>40%. (Prognostic Implications of Physiologic Investigation After Revascularization with Stent [POST-PCI FLOW]; NCT04684043).
背景
左心室收缩功能和血流储备分数（FFR）都是经皮冠状动脉介入治疗（PCI）后的预后因素。然而，这些预后因素在PCI术后患者风险分层中如何相互关联仍不清楚。
目的
本研究根据左心室射血分数（LVEF）评估PCI术后FFR的不同预后意义。
方法
从POST-PCI FLOW（支架血管重建后生理研究的预后意义）国际PCI术后FFR测量患者登记处中选取了2965例LVEF数据可用的患者。主要结局是2年时的心源性死亡或靶血管心肌梗死（TVMI）复合终点。次要结局是靶血管血运重建（TVR）和靶血管失败，靶血管失败是心源性死亡、TVMI或TVR的复合终点。
结果
PCI术后FFR与靶血管失败风险独立相关（每降低0.01：HR：1.029；95%CI：1.009-1.049；P=0.005）。PCI术后FFR与LVEF≤40%的患者发生心源性死亡或TVMI的风险增加相关（HR：1.145；95%CI：1.025-1.280；P=0.017），与LVEF>40%的患者发生TVR的风险增加相关（HR：1.028；95%CI：1.005-1.052；P=0.020）。PCI术后FFR≤0.80与LVEF≤40%组的心源性死亡或TVMI风险增加以及LVEF>40%组的TVR风险增加相关。PCI术后FFR对主要结局的预后影响根据LVEF有显著差异（P=0.019）。
结论
PCI术后FFR根据LVEF有不同的预后影响。PCI术后FFR≤0.80所提示的残余缺血是LVEF≤40%患者心源性死亡或TVMI的预后指标，并且与LVEF>40%患者的TVR相关。（支架血管重建后生理研究的预后意义[POST-PCI FLOW]；NCT04684043）
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