急性冠状动脉综合征患者冠状动脉旁路移植术与血流储备分数引导下经皮冠状动脉介入治疗后的结局比较
Outcomes After CABG Compared With FFR-Guided PCI in Patients Presenting With Acute Coronary Syndrome.
作者信息
Takahashi Kuniaki, Otsuki Hisao, Zimmermann Frederik M, Ding Victoria Y, Piroth Zsolt, Oldroyd Keith G, Wendler Olaf, Reardon Michael J, Desai Manisha, Woo Y Joseph, Yeung Alan C, De Bruyne Bernard, Pijls Nico H J, Fearon William F
机构信息
Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford University, California, USA.
St. Antonius Hospital, Nieuwegein, the Netherlands; Catharina Hospital, Eindhoven, the Netherlands.
出版信息
JACC Cardiovasc Interv. 2025 Apr 14;18(7):838-848. doi: 10.1016/j.jcin.2025.01.434.
BACKGROUND
There are limited data comparing coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) in patients presenting with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
OBJECTIVES
The aim of this study was to evaluate differences in outcomes in patients presenting with or without NSTE-ACS after CABG compared with fractional flow reserve (FFR)-guided PCI using current generation drug-eluting stents.
METHODS
The FAME 3 trial (Fractional flow reserve versus Angiography for Multivessel Evaluation; NCT02100722) was an investigator-initiated, randomized controlled trial to attest noninferiority of FFR-guided PCI using the current-generation drug-eluting stents to CABG with respect to the primary endpoint, defined as a composite of death, myocardial infarction (MI), stroke, or repeat revascularization at 1 year, in 1,500 patients with 3-vessel coronary artery disease. The prespecified key secondary endpoint was a composite of death, MI, or stroke at 3 years.
RESULTS
Of 1,500 patients enrolled, 587 (39.2%) presented with NSTE-ACS. Patients were followed up for a median of 1,080 days (Q1-Q3: 1,080-1,080 days). At 3 years, the risk of the composite of death, MI, or stroke was similar between patients presenting with NSTE-ACS and with chronic coronary syndrome (CCS) (11.8% vs 10.0%; adjusted HR [aHR]: 1.20; 95% CI: 0.81-1.77; P = 0.37). Patients presenting with NSTE-ACS had a similar risk of death, MI, or stroke at 3 years after CABG as compared with PCI (aHR: 0.98; 95% CI: 0.60-1.60; P = 0.94), whereas patients presenting with CCS had a significantly reduced risk after CABG compared with PCI (aHR: 0.58; 95% CI: 0.38-0.90; P = 0.02; P = 0.11), which was driven by a lower risk of MI (aHR: 0.32; 95% CI: 0.15-0.64; P = 0.002; P = 0.01).
CONCLUSIONS
The risk of death, MI, or stroke at 3 years was similar after CABG compared with FFR-guided PCI in patients presenting with NSTE-ACS, but reduced by CABG in patients presenting with CCS. (Fractional flow reserve versus Angiography for Multivessel Evaluation [FAME 3]; NCT02100722).
背景
在非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者中，比较冠状动脉旁路移植术（CABG）与经皮冠状动脉介入治疗（PCI）的资料有限。
目的
本研究旨在评估使用当代药物洗脱支架，在CABG后出现或未出现NSTE-ACS的患者与血流储备分数（FFR）引导的PCI相比，结局的差异。
方法
FAME 3试验（多支血管评估的血流储备分数与血管造影术对比试验；NCT02100722）是一项研究者发起的随机对照试验，在1500例三支血管冠状动脉疾病患者中，就主要终点（定义为1年时死亡、心肌梗死（MI）、中风或再次血运重建的复合终点）证明使用当代药物洗脱支架的FFR引导的PCI不劣于CABG。预先设定的关键次要终点是3年时死亡、MI或中风的复合终点。
结果
在纳入的1500例患者中，587例（39.2%）出现NSTE-ACS。患者的中位随访时间为1080天（四分位间距：1080 - 1080天）。在3年时，出现NSTE-ACS的患者与慢性冠状动脉综合征（CCS）患者相比，死亡、MI或中风复合终点的风险相似（11.8%对10.0%；校正风险比[aHR]：1.20；95%置信区间[CI]：0.81 - 1.77；P = 0.37）。与PCI相比，CABG后3年出现NSTE-ACS的患者死亡、MI或中风的风险相似（aHR：0.98；95% CI：0.60 - 1.60；P = 0.94），而与PCI相比，出现CCS的患者CABG后风险显著降低（aHR：0.58；95% CI：0.38 - 0.90；P = 0.02；P = 0.11），这是由较低的MI风险驱动的（aHR：0.32；95% CI：0.
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