Ziedses des Plantes Annemieke C, Scoccia Alessandra, Groenland Frederik T W, Tovar Forero Maria N, Tomaniak Mariusz, Kochman Janusz, Wojakowski Wojciech, Roleder-Dylewska Magda, Ameloot Koen, Adriaenssens Tom, den Dekker Wijnand K, Nuis Rutger-Jan, Kardys Isabella, Van Mieghem Nicolas M, Spitzer Ernest, Daemen Joost
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Dr. Molewaterplein 40, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Eur Heart J Cardiovasc Imaging. 2024 Dec 31;26(1):49-59. doi: 10.1093/ehjci/jeae212.
There is a paucity of data on the performance of angiography-derived vessel fractional flow reserve (vFFR) in coronary artery lesions of patients presenting with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Optical coherence tomography (OCT) allows for visualization of lumen dimensions and plaque integrity with high resolution. The aim of this study was to define the association between vFFR and OCT findings in intermediate coronary artery lesions in patients presenting with NSTE-ACS.
The FAST OCT study was a prospective, multicenter, single-arm study. Patients presenting with NSTE-ACS with intermediate to severe coronary artery stenosis in one or multiple vessels with TIMI 3 flow suitable for OCT imaging were eligible. Complete pre-procedural vFFR and OCT data were available in 226 vessels (in 188 patients). A significant association between vFFR and minimal lumen area (MLA) was observed, showing an average decrease of 20.4% (95% CI -23.9% to -16.7%) in MLA per 0.10 decrease in vFFR (adjusted P < 0.001). vFFR ≤ 0.80 showed a sensitivity of 56.7% and specificity of 92.5% to detect MLA ≤ 2.5 mm2. Conversely, vFFR had a poor to moderate discriminative ability to detect plaque instability (sensitivity, 46.9%; specificity, 71.6%).
In patients with NSTE-ACS, vFFR is significantly associated with OCT-detected MLA, and vFFR ≤ 0.80 is highly predictive of the presence of significant disease based on OCT. Conversely, the sensitivity of vFFR ≤ 0.80 to detect OCT-assessed significant disease was low, indicating that the presence of significant OCT findings cannot be ruled out based on a negative vFFR.
关于血管造影衍生的血管血流储备分数（vFFR）在非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者冠状动脉病变中的表现，数据匮乏。光学相干断层扫描（OCT）能够高分辨率地显示管腔尺寸和斑块完整性。本研究的目的是确定NSTE-ACS患者冠状动脉中度病变中vFFR与OCT结果之间的关联。
FAST OCT研究是一项前瞻性、多中心、单臂研究。符合条件的患者为患有NSTE-ACS且单支或多支血管存在中度至重度冠状动脉狭窄、TIMI 3级血流且适合OCT成像者。226支血管（188例患者）有完整的术前vFFR和OCT数据。观察到vFFR与最小管腔面积（MLA）之间存在显著关联，vFFR每降低0.10，MLA平均降低20.4%（95%CI -23.9%至-16.7%）（校正P<0.001）。vFFR≤0.80检测MLA≤2.5 mm2的敏感性为56.7%，特异性为92.5%。相反，vFFR检测斑块不稳定性的鉴别能力较差至中等（敏感性为46.9%；特异性为71.6%）。
在NSTE-ACS患者中，vFFR与OCT检测的MLA显著相关，基于OCT，vFFR≤0.
