在非 ST 段抬高型急性冠状动脉综合征的中国真实世界队列中，静息全周期比与血流储备分数评估冠状动脉功能的相关性和一致性：一项回顾性观察研究。
Correlation and consistency between resting full-cycle ratio and fractional flow reserve in assessing coronary artery function in a Chinese real-world cohort with non-ST-segment elevation acute coronary syndrome: a retrospective observational study.
机构信息
Department of Cardiology, Guangdong Medical University, Dongguan Songshan Lake Central Hospital, Dongguan, Guangdong, China.
Department of Cardiology, Hebei Medical University, Cangzhou Central Hospital, Cangzhou, Hebei, China.
出版信息
BMJ Open. 2024 Aug 22;14(8):e082913. doi: 10.1136/bmjopen-2023-082913.
OBJECTIVE
The study aimed to investigate the correlation and consistency between resting full-cycle ratio (RFR) and fractional flow reserve (FFR) in functional assessment of coronary arteries in a Chinese real-world cohort with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
DESIGN
Retrospective study.
SETTING
A single-centre study in China.
PARTICIPANTS
A total of 292 diseased vessels of 226 Chinese patients with NSTE-ACS at Cangzhou Central Hospital of Hebei Medical University from September 2021 to June 2023 were included.
METHODS
The correlation between RFR and FFR, resting ratio of distal coronary artery pressure (Pd) to aortic pressure (Pa) and FFR were analysed by using Person correlation, and the consistency between RFR and FFR, resting Pd/Pa and FFR were assessed by Bland-Altman test. The diagnostic values of RFR and resting Pd/Pa for predicting FFR≤0.80 were evaluated according to the receiver operating characteristic (ROC) curves.
RESULTS
RFR and resting Pd/Pa were significantly correlated with FFR, and correlation coefficients were 0.787 (p<0.001) and 0.765 (p<0.001), respectively. We found no significant differences between RFR and FFR or between resting Pd/Pa and FFR. The areas under the ROC curves for predicting FFR≤0.80 were 0.883 (p<0.001) for RFR and 0.858 (p<0.001) for resting Pd/Pa, and the optimal critical values were 0.91 for RFR and 0.93 for resting Pd/Pa. The accuracy, sensitivity, specificity and positive and negative predictive values of RFR≤0.91 for predicting FFR≤0.80 were 79.1%, 84.0%, 76.6%, 65.1% and 90.2%, respectively.
CONCLUSION
The current study suggests that RFR exhibits a good correlation and consistency with FFR in patients with NSTE-ACS. RFR is expected to significantly enhance the application of coronary artery functional assessment in clinical practice, thereby providing patients with more precise revascularisation strategies.
目的
本研究旨在探讨静息全周期比（RFR）与非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）患者冠状动脉功能评估中分数血流储备（FFR）的相关性和一致性。
设计
回顾性研究。
地点
中国的单中心研究。
参与者
共纳入 2021 年 9 月至 2023 年 6 月在河北医科大学沧州中心医院就诊的 226 例 NSTE-ACS 患者的 292 支病变血管。
方法
通过 Pearson 相关分析评估 RFR 与 FFR、静息远端冠状动脉压力（Pd）与主动脉压力（Pa）比值与 FFR 的相关性，采用 Bland-Altman 检验评估 RFR 与 FFR、静息 Pd/Pa 与 FFR 的一致性。根据受试者工作特征（ROC）曲线评估 RFR 和静息 Pd/Pa 预测 FFR≤0.80 的诊断价值。
结果
RFR 和静息 Pd/Pa 与 FFR 呈显著相关，相关系数分别为 0.787（p<0.001）和 0.765（p<0.001）。RFR 与 FFR 或静息 Pd/Pa 与 FFR 之间无显著差异。预测 FFR≤0.80 的 ROC 曲线下面积为 RFR 的 0.883（p<0.001）和静息 Pd/Pa 的 0.858（p<0.001），最佳临界值分别为 RFR 的 0.91 和静息 Pd/Pa 的 0.93。RFR≤0.91 预测 FFR≤0.80 的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为 79.1%、84.0%、76.6%、65.1%和 90.2%。
结论
本研究表明，在 NSTE-ACS 患者中，RFR 与 FFR 具有良好的相关性和一致性。RFR 有望显著提高冠状动脉功能评估在临床实践中的应用，从而为患者提供更精准的血运重建策略。
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