Lammens Johanna, Motoc Andreea, Tanaka Kaoru, Belsack Dries, Vandeloo Bert, Lochy Stijn, Schoors Danny, Van Loo Ines, De Potter Tom, Michiels Vincent, Tsugu Toshimitsu, Van Dalem Annelien, Thorrez Yves, Magne Julien, De Mey Johan, Cosyns Bernard, Argacha Jean-François
Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Int J Cardiol. 2025 Jul 15;431:133245. doi: 10.1016/j.ijcard.2025.133245. Epub 2025 Apr 9.
Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFR) strategy significantly decreases unnecessary invasive coronary angiography and refines the appropriateness of revascularization decision. The present study aimed to evaluate how FFR guided - strategy impacts outcomes postrevascularization.
We included patients with suspected obstructive coronary artery disease (OCAD in a registry from 2013 to 2021. FFR entered Heart-Team decision from 2017. Propensity score adjusted Cox - and logistic - regression analyzed FFR's impact on post- revascularization major adverse cardiovascular events (MACE) and myocardial injury (PMI).
Among 7541 patients, 1601 had suspected OCAD. 559 patients underwent revascularization: 69.0 % PCI, 29.7 % CABG and 1.2 % both. 252(45.1 %) patients underwent FFR. Over 4.4 ± 2.2 years, 137(24.5 %) patients experienced MACE. FFR was associated with a trend toward reduced MACE (HR 0.736, 95 % CI 0.513-1.055, p = 0.095) and significantly reduced all-cause mortality (HR 0.476, 95 % CI 0.230-0.985, p = 0.046). In the post-2017 cohort (413 patients, follow-up 3.7 ± 1.5 years), FFR significantly reduced MACE (HR 0.610, 95 % CI 0.390-0.954, P = 0.030) and all-cause mortality (HR 0.285, 95 % CI 0.104-0.779, P = 0.014). In CABG patients, FFR was associated with lower PMI incidence (5.3 % vs. 15.6 %, p = 0.044). Multivariable analysis revealed no significant association between FFR use and PMI.
Revascularization decision-making with FFR translates into better post-revascularization outcomes, primarily by reducing MACE through lower mortality. There was no clear impact on PMI. These findings suggests that FFR's value lies indeed in improving patient selection for revascularization, but warrants further confirmation in randomized clinical trials.
冠状动脉计算机断层扫描血管造影（CCTA）衍生的血流储备分数（FFR）策略显著减少了不必要的有创冠状动脉造影，并优化了血运重建决策的合理性。本研究旨在评估FFR指导策略如何影响血运重建后的结局。
我们纳入了2013年至2021年登记处中疑似阻塞性冠状动脉疾病（OCAD）的患者。FFR从2017年开始纳入心脏团队决策。倾向评分调整后的Cox回归和逻辑回归分析了FFR对血运重建后主要不良心血管事件（MACE）和心肌损伤（PMI）的影响。
在7541例患者中，1601例疑似OCAD。559例患者接受了血运重建：69.0%为经皮冠状动脉介入治疗（PCI），29.7%为冠状动脉旁路移植术（CABG），1.2%两者都做。252例（45.1%）患者接受了FFR检查。在4.4±2.2年的时间里，137例（24.5%）患者发生了MACE。FFR与MACE减少趋势相关（风险比[HR]0.736，95%置信区间[CI]0.513 - 1.055，p = 0.095），且全因死亡率显著降低（HR 0.476，95% CI 0.230 - 0.985，p = 0.046）。在2017年后的队列（413例患者，随访3.7±1.5年）中，FFR显著降低了MACE（HR 0.610，95% CI 0.390 - 0.954，P = 0.030）和全因死亡率（HR 0.285，95% CI 0.104 - 0.779，P = 0.014）。在CABG患者中，FFR与较低的PMI发生率相关（5.3%对15.6%，p = 0.044）。多变量分析显示FFR的使用与PMI之间无显著关联。
采用FFR进行血运重建决策可带来更好的血运重建后结局，主要是通过降低死亡率来减少MACE。对PMI没有明显影响。这些发现表明FFR的价值确实在于改善血运重建的患者选择，但需要在随机临床试验中进一步证实。
