Kurita Tairo, Kuramitsu Shoichi, Ishii Masanobu, Takasaki Akihiro, Domei Takenori, Matsuo Hitoshi, Horie Kazunori, Ando Hirohiko, Terai Hidenobu, Kikuta Yuetsu, Ishihara Takayuki, Saigusa Tatsuya, Sakamoto Tomohiro, Suematsu Nobuhiro, Shiono Yasutsugu, Asano Taku, Tsujita Kenichi, Masamura Katsuhiko, Doijiri Tatsuki, Toyota Fumitoshi, Ogita Manabu, Shiraishi Jun, Harada Ken, Isogai Hiroyuki, Anai Reo, Sonoda Shinjo, Yokoi Hiroyoshi, Tanaka Nobuhiro, Dohi Kaoru
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine Mie Japan.
Department of Cardiovascular Medicine, Sapporo Cardiovascular Clinic, Sapporo Heart Center Sapporo Japan.
Circ Rep. 2024 Jul 20;6(8):313-321. doi: 10.1253/circrep.CR-24-0069. eCollection 2024 Aug 9.
Because the clinical benefit of antiplatelet therapy (APT) for patients with nonsignificant coronary artery disease (CAD) remains poorly understood, we evaluated it in patients after fractional flow reserve (FFR)-guided deferral of revascularization.
From the J-CONFIRM (Long-Term Outcomes of Japanese Patients with Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry), we investigated 265 patients with deferred lesions who did not require APT for secondary prevention of cardiovascular disease. A 2-year landmark analysis assessed the relationship between APT at 2 years and 5-year major cardiac adverse events (MACE: composite of all-cause death, target vessel-related myocardial infarction, clinically driven target vessel revascularization). Of the 265 patients, 163 (61.5%) received APT. The 5-year MACE did not significantly differ between the APT and non-APT groups after adjustment for baseline clinical characteristics (9.2% vs. 6.9%, inverse probability weighted hazard ratio, 1.40 [95% confidence interval, 0.53-3.69]; P=0.49). There was a marginal interaction between the effect of APT on MACE and FFR values (< or ≥0.84) (P for interaction=0.066).
The 5-year outcomes after FFR-guided deferral of revascularization did not significantly differ between the APT and non-APT groups, suggesting that APT might not be a critical requirement for nonsignificant obstructive CAD patients not requiring APT for secondary prevention of cardiovascular disease.
由于抗血小板治疗（APT）对非显著冠状动脉疾病（CAD）患者的临床益处仍知之甚少，我们在血流储备分数（FFR）指导下延迟血运重建的患者中对其进行了评估。
从J-CONFIRM（基于多中心注册研究中血流储备分数的日本冠状动脉介入延迟患者的长期结局）中，我们调查了265例延迟病变患者，这些患者不需要APT进行心血管疾病的二级预防。一项为期2年的标志性分析评估了2年时的APT与5年主要心脏不良事件（MACE：全因死亡、靶血管相关心肌梗死、临床驱动的靶血管血运重建的复合终点）之间的关系。在这265例患者中，163例（61.5%）接受了APT。在对基线临床特征进行调整后，APT组和非APT组的5年MACE无显著差异（9.2%对6.9%，逆概率加权风险比，1.40[95%置信区间，0.53 - 3.69]；P = 0.49）。APT对MACE的影响与FFR值（<或≥0.84）之间存在边缘性交互作用（交互作用P值 = 0.066）。
在FFR指导下延迟血运重建后的5年结局，APT组和非APT组之间无显著差异，这表明对于不需要APT进行心血管疾病二级预防的非显著阻塞性CAD患者，APT可能不是关键需求。
