Department of Cardiovascular Medicine (K.M., Y.K., T.I., K.S., H. Matama, H. Miura, S.H., M.F., S.Y., K. Nakao, K.T., F.O., Y.A., T.N.), National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Preventive Medicine and Epidemiology (E.K., K. Nishimura), National Cerebral and Cardiovascular Center, Osaka, Japan.
Circ Cardiovasc Interv. 2024 Sep;17(9):e013830. doi: 10.1161/CIRCINTERVENTIONS.124.013830. Epub 2024 Jul 25.
Cardiovascular events still occur at intermediate stenosis with fractional flow reserve (FFR) ≥0.81, underscoring the additional measure to evaluate this residual risk. A reduction in distal coronary artery pressure/aortic pressure (Pd/Pa) from baseline to hyperemia (ie, change in Pd/Pa) reflects lipidic burden within vessel walls. We hypothesized that this physiological measure might stratify the risk of future cardiac events at deferrable lesions.
Lesion- (899 intermediate lesions) and patient-based (899 deferred patients) analyses in those with FFR ≥0.81 were conducted to investigate the association between change in Pd/Pa and target lesion failure (TLF) and major adverse cardiac events at 7 years, respectively.
The occurrence of TLF and major adverse cardiac events was 6.7% and 13.4%, respectively. The incidence of target lesion-related nonfatal myocardial infarction was 0.6%. Lesions with TLF had a greater change in Pd/Pa (0.11±0.03 versus 0.09±0.04; =0.002), larger diameter stenosis (51.0±9.2% versus 46.4±12.4%; =0.048), and smaller FFR (0.84 [0.82-0.87] versus 0.86 [0.83-0.90]; =0.02). Change in Pd/Pa (per 0.01 increase) predicted TLF (odds ratio, 1.16 [95% CI, 1.05-1.28]; =0.002) and major adverse cardiac event (odds ratio, 1.08 [95% CI, 1.01-1.16]; =0.03). Lesions with change in Pd/Pa ≥0.10 had 2.94- and 1.85-fold greater likelihood of TLF (95% CI, 1.30-6.69; =0.01) and major adverse cardiac event (95% CI, 1.08-3.17; =0.03), respectively. Lesions with FFR ≤0.85 had a substantially higher likelihood of TLF when there is a change in Pd/Pa ≥0.10 (12.4% versus 2.9%; hazard ratio, 3.60 [95% CI, 1.01-12.80]; =0.04). However, change in Pd/Pa did not affect TLF risk in lesions with FFR ≥0.86 (3.8% versus 3.7%; hazard ratio, 0.56 [95% CI, 0.06-5.62]; =0.62).
Despite deferrable FFR values, lesions and patients with a change in Pd/Pa ≥0.10 had higher cardiovascular risk. Change in Pd/Pa might help stratify lesion- and patient-level risks of future cardiac events in those with FFR ≥0.81.
即使在狭窄程度为 Fractional Flow Reserve（FFR）≥0.81 的中度狭窄病变中，仍会发生心血管事件，这突显了需要额外的评估手段来评估这种残余风险。从基线到充血时的冠状动脉远端压力/主动脉压力（Pd/Pa）变化（即 Pd/Pa 的变化）反映了血管壁内的脂质负担。我们假设这种生理指标可能会对可延迟处理病变的未来心脏事件风险进行分层。
对 FFR≥0.81 的患者进行基于病变（899 个中度狭窄病变）和基于患者（899 名延迟处理的患者）的分析，分别研究 Pd/Pa 变化与目标病变失败（TLF）和主要不良心脏事件之间的关系，随访时间为 7 年。
TLF 和主要不良心脏事件的发生率分别为 6.7%和 13.4%。与目标病变相关的非致死性心肌梗死的发生率为 0.6%。发生 TLF 的病变 Pd/Pa 变化更大（0.11±0.03 比 0.09±0.04；=0.002），直径狭窄更严重（51.0±9.2% 比 46.4±12.4%；=0.048），FFR 更小（0.84[0.82-0.87]比 0.86[0.83-0.90]；=0.02）。Pd/Pa 变化（每增加 0.01）预测 TLF（比值比，1.16[95%CI，1.05-1.28]；=0.002）和主要不良心脏事件（比值比，1.08[95%CI，1.01-1.16]；=0.03）。Pd/Pa 变化≥0.10 的病变发生 TLF 的可能性增加 2.94-1.85 倍（95%CI，1.30-6.69；=0.01）和主要不良心脏事件的可能性增加 1.08-3.17 倍（95%CI，1.08-3.17；=0.03）。FFR≤0.85 的病变在 Pd/Pa 变化≥0.10 时发生 TLF 的可能性显著增加（12.4%比 2.9%；危险比，3.60[95%CI，1.01-12.80]；=0.04）。然而，Pd/Pa 变化并不影响 FFR≥0.86 病变的 TLF 风险（3.8%比 3.7%；危险比，0.56[95%CI，0.06-5.62]；=0.62）。
尽管 FFR 值可延迟处理，但 Pd/Pa 变化≥0.10 的病变和患者具有更高的心血管风险。Pd/Pa 变化可能有助于对 FFR≥0.81 的患者进行未来心脏事件的病变和患者水平风险分层。
