ST段抬高型心肌梗死合并多支血管病变患者非罪犯病变的虚拟生理分析：COMPLETE试验的一项子研究
Virtual physiological analysis of non-culprit disease in patients with STEMI and multivessel disease: a substudy of the COMPLETE trial.
作者信息
Williams Gareth J, Taylor Daniel J, Al Baraikan Abdulaziz, Haley Hazel, Ghobrial Mina, Knight Matthew, Anigboro Kenneth, Rammohan Vignesh, Gosling Rebecca, Newman Tom, Mills Mark, Hose Rod, Wood David A, Cairns John A, Ramasundarahettige Chinthanie, Khatun Rutaba, Nguyen Helen, Mehta Shamir R, Storey Robert F, Gunn Julian P, Morris Paul D
机构信息
Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK.
NIHR Sheffield Biomedical Research Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Beech Hill Road, Sheffield S10 2RX, UK.
出版信息
Eur Heart J Open. 2025 Jun 11;5(3):oeaf057. doi: 10.1093/ehjopen/oeaf057. eCollection 2025 May.
AIMS
In the complete revascularization with multivessel PCI for myocardial infarction (COMPLETE) trial, staged complete revascularization in patients with ST-segment-elevation myocardial infarction (MI) reduced major adverse cardiovascular events compared with culprit-only revascularization. Inclusion was based on angiographic criteria.
OBJECTIVES
We modelled non-culprit virtual fractional flow reserve (vFFR) and investigated interactions between physiological lesion severity and the benefits of complete revascularization in COMPLETE.
METHODS AND RESULTS
All suitable angiograms from COMPLETE underwent software-based 3-dimensional (3D) arterial reconstruction and analysis of 3D-quantitative coronary angiography (QCA) and vFFR using computational fluid dynamics software. Physiological lesion significance was defined as vFFR ≤0.80 and was compared with operators' visual angiographic analysis, 2D-QCA and 3D-QCA. vFFR was computed in 635 patients (710 lesions). 302 patients (48%) had ≥1 physiologically significant lesion and 333 (52%) had none. 321 (45%) lesions were physiologically significant and 389 (55%) were not. There was no statistically significant interaction between physiological lesion significance and any of the trial co-primary or key secondary clinical outcomes, or an exploratory outcome of ischaemia-driven revascularization without preceding MI (all interaction > 0.30). 3D-QCA predicted vFFR significance more accurately than visual and 2D-QCA (concordance 73% vs. 49% vs. 59%, respectively).
CONCLUSION
In this virtual physiological substudy of the COMPLETE trial, 52% of patients lacked any physiologically significant lesions and the benefits of complete revascularization appeared to be independent of physiological lesion significance. 3D-QCA was a better predictor of physiological significance than either 2D-QCA or operator visual analysis. Further research is warranted to compare angiography-guided and physiology-guided complete revascularization strategies.
目的
在心肌梗死多支血管PCI完全血运重建（COMPLETE）试验中，与仅对罪犯血管进行血运重建相比，ST段抬高型心肌梗死（MI）患者进行分期完全血运重建可减少主要不良心血管事件。纳入标准基于血管造影标准。
目标
我们对非罪犯血管虚拟血流储备分数（vFFR）进行建模，并研究COMPLETE试验中生理病变严重程度与完全血运重建益处之间的相互作用。
方法与结果
COMPLETE试验中所有合适的血管造影图像均进行基于软件的三维（3D）动脉重建，并使用计算流体动力学软件对3D定量冠状动脉造影（QCA）和vFFR进行分析。将生理病变意义定义为vFFR≤0.80，并与术者的血管造影视觉分析、二维QCA和三维QCA进行比较。对635例患者（710处病变）计算vFFR。302例患者（48%）有≥1处具有生理意义的病变，333例（52%）无此类病变。321处（45%）病变具有生理意义，389处（55%）不具有生理意义。生理病变意义与任何一项试验共同主要或关键次要临床结局，或无先前MI的缺血驱动血运重建的探索性结局之间均无统计学显著相互作用（所有相互作用P>0.30）。三维QCA比视觉分析和二维QCA更准确地预测vFFR意义（一致性分别为73%、49%和59%）。
结论
在COMPLETE试验的这项虚拟生理亚研究中，52% 的患者没有任何具有生理意义的病变，完全血运重建的益处似乎与生理病变意义无关。三维QCA比二维QCA或术者视觉分析更能准确预测生理意义。有必要进一步研究以比较血管造影引导和生理引导的完全血运重建策略。
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