Hung Yik-Ming, Xuan Hao-Chen, Ren Qing-Wen, Huang Jia-Yi, Yu Si-Yeung, Tse Yi-Kei, Zhang Jing-Nan, Gu Wen-Li, Guo Ran, Leung Calvin Ka-Lam, Yiu Kai-Hang
Division of Cardiology, Department of Medicine The University of Hong Kong-Shen Zhen Hospital Shen Zhen China.
Division of Cardiology, Department of Medicine, The University of Hong Kong Queen Mary Hospital Hong Kong.
J Am Heart Assoc. 2025 Jan 7;14(1):e036717. doi: 10.1161/JAHA.124.036717. Epub 2024 Dec 24.
Risk stratification of patients with symptomatic nonobstructive coronary artery disease remains uncertain. Our study assessed the clinical value of single-vessel, multivessel, and 3-vessel computational angiography-derived fractional flow reserve (caFFR) measurement in patients with nonobstructive coronary artery disease.
We enrolled patients with ≤50% stenosis with a caFFR value ≥0.8 in all 3 coronary arteries on coronary angiography. The sum of caFFR values in the 3 vessels was computed for each patient. Patient stratification was based on the median value of the following criteria: single-vessel analysis, multivessel analysis, and 3-vessel analysis. The primary end point of this study was major adverse cardiac events at 5 years, defined as a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization. A total of 490 patients were included. The 5-year major adverse cardiac event rates in single-vessel analysis were statistically insignificant between low- and high-caFFR groups (left anterior descending artery [=0.163]; left circumflex artery [=0.797]; right coronary artery [=0.127]). In multivessel analysis, patients in the multiple-vessel low-caFFR group (with 2-3 vessels lower than median value of all coronary arteries) showed an increased risk of 5-year major adverse cardiac events compared with patients in the single-vessel low-caFFR group (0-1 vessel) (hazard ratio [HR], 2.648 [95% CI, 1.141-6.145]; =0.023). In 3-vessel analysis, patients in the low 3-vessel caFFR group demonstrated a greater 5-year major adverse cardiac event risk than the high 3-vessel caFFR group (HR, 2.43 [95% CI, 1.087-5.433]; =0.031).
We demonstrated that both multiple-vessel and 3-vessel caFFR measurements serve as valuable prognostic indicators for risk assessment in patients with nonobstructive coronary artery disease.
有症状的非阻塞性冠状动脉疾病患者的风险分层仍不明确。我们的研究评估了单支血管、多支血管和三支血管计算机断层血管造影衍生的血流储备分数（caFFR）测量在非阻塞性冠状动脉疾病患者中的临床价值。
我们纳入了冠状动脉造影显示所有三支冠状动脉狭窄≤50%且caFFR值≥0.8的患者。计算每位患者三支血管caFFR值的总和。患者分层基于以下标准的中位数：单支血管分析、多支血管分析和三支血管分析。本研究的主要终点是5年时的主要不良心脏事件，定义为心脏死亡、心肌梗死和缺血驱动的血运重建的复合终点。共纳入490例患者。在单支血管分析中，低caFFR组和高caFFR组之间5年主要不良心脏事件发生率无统计学差异（左前降支[=0.163]；左旋支[=0.797]；右冠状动脉[=0.127]）。在多支血管分析中，多支血管低caFFR组（2 - 3支血管低于所有冠状动脉的中位数）患者与单支血管低caFFR组（0 - 1支血管）患者相比，5年主要不良心脏事件风险增加（风险比[HR]，2.648[95%CI，1.141 - 6.145]；=0.023）。在三支血管分析中，低三支血管caFFR组患者5年主要不良心脏事件风险高于高三支血管caFFR组（HR，2.43[95%CI，1.087 - 5.433]；=0.031）。
我们证明多支血管和三支血管caFFR测量均可作为非阻塞性冠状动脉疾病患者风险评估的有价值的预后指标。
