Department of Medicine 2 - Cardiology and Angiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
Department of Medicine 1 - Cardiology, Nephrology, Intensive Care and Rhythmology, St. Johannes Hospital Dortmund, Dortmund, Germany.
Clin Res Cardiol. 2024 Jul;113(7):1081-1091. doi: 10.1007/s00392-024-02463-w. Epub 2024 Jun 4.
Despite the recommendation of coronary physiology to guide revascularization in angiographically intermediate stenoses without established correlation to ischemia, its uptake in clinical practice is slow.
This study aimed to analyze the use of coronary physiology in clinical practice.
Based on a multicenter registry (Fractional Flow Reserve Fax Registry, F(FR), ClinicalTrials.gov identifier NCT03055910), clinical use, consequences, and complications of coronary physiology were systematically analyzed.
F(FR) enrolled 2,000 patients with 3,378 intracoronary pressure measurements. Most measurements (96.8%) were performed in angiographically intermediate stenoses. Out of 3,238 lesions in which coronary physiology was used to guide revascularization, revascularization was deferred in 2,643 (78.2%) cases. Fractional flow reserve (FFR) was the most common pressure index used (87.6%), with hyperemia induced by an intracoronary bolus of adenosine in 2,556 lesions (86.4%) and intravenous adenosine used for 384 measurements (13.0%). The route of adenosine administration did not influence FFR results (change-in-estimate -3.1% for regression model predicting FFR from diameter stenosis). Agreement with the subsequent revascularization decision was 93.4% for intravenous and 95.0% for intracoronary adenosine (p = 0.261). Coronary artery occlusion caused by the pressure wire was reported in two cases (0.1%) and dissection in three cases (0.2%), which was fatal once (0.1%).
In clinical practice, intracoronary pressure measurements are mostly used to guide revascularization decisions in angiographically intermediate stenoses. Intracoronary and intravenous administration of adenosine seem equally suited. While the rate of serious complications of wire-based intracoronary pressure measurements in clinical practice seems to be low, it is not negligible.
尽管血管造影学中间狭窄但与缺血无关的情况下推荐采用冠脉生理学指导血运重建，但该方法在临床实践中的应用仍较为缓慢。
本研究旨在分析冠脉生理学在临床实践中的应用。
基于多中心注册研究（血流储备分数传真登记研究，F(FR)，ClinicalTrials.gov 标识符 NCT03055910），系统分析了冠脉生理学的临床应用、结果和并发症。
F(FR)共纳入 2000 例患者，共进行了 3378 次冠状动脉压力测量。大多数测量（96.8%）在血管造影学中间狭窄病变中进行。在 3238 个使用冠脉生理学指导血运重建的病变中，2643 个（78.2%）病变中推迟了血运重建。血流储备分数（FFR）是最常用的压力指数（87.6%），其中 2556 个病变（86.4%）采用冠状动脉内腺苷弹丸注射诱导充血，384 个病变（13.0%）采用静脉内腺苷。腺苷给药途径不影响 FFR 结果（预测 FFR 与直径狭窄的回归模型中的估计值变化为-3.1%）。静脉内腺苷和冠状动脉内腺苷的后续血运重建决策的一致性分别为 93.4%和 95.0%（p=0.261）。有两例（0.1%）报道因压力导丝导致冠状动脉闭塞，三例（0.2%）报道夹层，其中一例（0.1%）为致命性。
在临床实践中，冠状动脉内压力测量主要用于指导血管造影学中间狭窄病变的血运重建决策。冠状动脉内和静脉内给予腺苷似乎同样适用。虽然基于导丝的冠状动脉内压力测量在临床实践中的严重并发症发生率似乎较低，但不容忽视。
