经皮冠状动脉介入治疗后血流储备分数对5年临床结局的影响（FFR研究）
Impact of Post Percutaneous Coronary Intervention Fractional Flow Reserve on 5-Year Clinical Outcomes (The FFR SEARCH Study).
作者信息
Groenland Frederik T W, Ziedses des Plantes Annemieke C, Neleman Tara, Scoccia Alessandra, van der Eijk Jari A, Masdjedi Kaneshka, van Zandvoort Laurens J C, den Dekker Wijnand K, Wilschut Jeroen M, Kardys Isabella, Cummins Paul, Diletti Roberto, Van Mieghem Nicolas M, Daemen Joost
机构信息
Department of (Interventional) Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Cardiology, Admiraal de Ruyter Hospital, Goes, the Netherlands.
出版信息
Catheter Cardiovasc Interv. 2025 May;105(6):1523-1529. doi: 10.1002/ccd.31493. Epub 2025 Mar 12.
BACKGROUND
Fractional flow reserve (FFR) following percutaneous coronary intervention (PCI) can be used to evaluate procedural success and to guide stent optimization. Several studies have demonstrated that lower FFR after stent implantation is associated with increased adverse event rates up to 2 years. However, the impact of post-PCI FFR on very long-term clinical outcome remains unknown.
METHODS
The FFR SEARCH study is a single-center, prospective, observational study including consecutive patients undergoing PCI with stent implantation from 2016 to 2017. FFR measurement was performed after angiographically successful PCI using a dedicated microcatheter. The primary endpoint was target vessel failure (TVF) at 5 years, a composite of cardiovascular death, target vessel myocardial infarction and target vessel revascularization. The optimal post-PCI FFR cutoff value to predict 5-year TVF was determined based on the maximum log-rank statistic.
RESULTS
Post-PCI FFR measurements were successfully performed in 959 patients. Mean age was 64.0 ± 11.9 years, 72.5% of the patients were male and 33.6% presented with ST-segment elevation myocardial infarction. The left anterior descending artery was the target vessel in 53.5%. The optimal post-PCI FFR cutoff value was ≤ 0.90. TVF occurred in 18.4% of patients with a post-PCI FFR ≤ 0.90 versus 11.6% in patients with a post-PCI FFR > 0.90 (adjusted HR 1.65 (95% CI 1.11-2.48, p = 0.014)).
CONCLUSIONS
This large prospective observational study demonstrates that post-PCI FFR ≤ 0.90 is associated with a higher TVF rate at 5 years.
背景
经皮冠状动脉介入治疗（PCI）后的血流储备分数（FFR）可用于评估手术成功率并指导支架优化。多项研究表明，支架植入后较低的FFR与长达2年的不良事件发生率增加相关。然而，PCI术后FFR对极长期临床结局的影响仍不清楚。
方法
FFR SEARCH研究是一项单中心、前瞻性、观察性研究，纳入了2016年至2017年连续接受PCI并植入支架的患者。在血管造影成功的PCI术后，使用专用微导管进行FFR测量。主要终点是5年时的靶血管失败（TVF），这是心血管死亡、靶血管心肌梗死和靶血管血运重建的复合终点。基于最大对数秩统计量确定预测5年TVF的最佳PCI术后FFR临界值。
结果
959例患者成功进行了PCI术后FFR测量。平均年龄为64.0±11.9岁，72.5%的患者为男性，33.6%的患者表现为ST段抬高型心肌梗死。左前降支是53.5%患者的靶血管。最佳PCI术后FFR临界值≤0.90。PCI术后FFR≤0.90的患者中18.4%发生TVF，而PCI术后FFR>0.90的患者中这一比例为11.6%（校正HR 1.65（95%CI 1.11 - 2.48，p = 0.014））。
结论
这项大型前瞻性观察性研究表明，PCI术后FFR≤0.90与5年时较高的TVF发生率相关。
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