Ohashi Hirofumi, Kuramitsu Shoichi, Takashima Hiroaki, Matsuo Hitoshi, Horie Kazunori, Terai Hidenobu, Kikuta Yuetsu, Ishihara Takayuki, Saigusa Tatsuya, Sakamoto Tomohiro, Suematsu Nobuhiro, Shiono Yasutsugu, Asano Taku, Tsujita Kenichi, Masamura Katsuhiko, Doijiri Tatsuki, Sasaki Yohei, Ogita Manabu, Kurita Tairo, Matsuo Akiko, Harada Ken, Yaginuma Kenji, Sonoda Shinjo, Amano Tetsuya, Yokoi Hiroyoshi, Tanaka Nobuhiro
Department of Cardiology, Aichi Medical University, Aichi, Japan.
Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
J Soc Cardiovasc Angiogr Interv. 2023 May 2;2(3):100632. doi: 10.1016/j.jscai.2023.100632. eCollection 2023 May-Jun.
Little evidence is available about the long-term safety of fractional flow reserve (FFR)-guided deferral of revascularization in infarct-related artery (IRA) lesions, especially when measuring FFR in the late setting after myocardial infarction (MI). This study aimed to assess the long-term outcomes after deferral of revascularization in IRA lesions based on FFR assessed in the late phase of post-MI.
From the J-CONFIRM registry (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry), data on 1447 lesions (1263 patients) were divided into 2 groups: the IRA and non-IRA groups. The primary study end point was the cumulative 5-year incidence of target vessel failure (TVF), such as cardiac death, target vessel-related MI, and clinically driven target vessel revascularization.
Of the 1447 lesions, 138 (9.5%) were classified into the IRA group. The median duration of FFR measurement was 716 days after MI. The frequency of visual-functional mismatches (ie, FFR >0.80 and percent diameter stenosis ≥50% or FFR ≤0.80 and percent diameter stenosis <50%) was comparable between the IRA and non-IRA groups (31.9% vs 36.3%). The cumulative 5-year incidence of TVF did not differ between the groups (9.2% vs 11.8%; inverse probability-weighted hazard ratio, 1.18, 95% confidence intervals, 0.48-2.91, = .71). Similar results were observed irrespective of regional wall motion assessed by ultrasonic cardiography and acute MI type.
The 5-year TVF rate did not differ between the IRA and non-IRA lesions when deferring revascularization guided by FFR in the late setting of post-MI.
关于梗死相关动脉（IRA）病变中基于血流储备分数（FFR）指导延迟血运重建的长期安全性，几乎没有证据，尤其是在心肌梗死（MI）后期测量FFR时。本研究旨在评估基于MI后期评估的FFR延迟IRA病变血运重建后的长期结局。
从J-CONFIRM注册研究（基于血流储备分数的日本患者冠状动脉介入延迟的多中心注册研究的长期结局）中，1447个病变（1263例患者）的数据被分为两组：IRA组和非IRA组。主要研究终点是靶血管失败（TVF）的累积5年发生率，如心源性死亡、靶血管相关MI和临床驱动的靶血管血运重建。
在1447个病变中，138个（9.5%）被分类到IRA组。FFR测量的中位时间是MI后716天。IRA组和非IRA组之间视觉功能不匹配（即FFR>0.80且直径狭窄百分比≥50%或FFR≤0.80且直径狭窄百分比<50%）的频率相当（31.9%对36.3%）。两组之间TVF的累积5年发生率没有差异（9.2%对11.8%；逆概率加权风险比，1.18，95%置信区间，0.48 - 2.91，P = 0.71）。无论通过超声心动图评估的局部室壁运动和急性MI类型如何，均观察到相似结果。
在MI后期，当基于FFR指导延迟血运重建时，IRA病变和非IRA病变的5年TVF率没有差异。
