多支血管病变急性心肌梗死中非罪犯病变部位及血流储备分数指导的血运重建：FRAME-AMI亚研究

Non-culprit Lesion Location and FFR-guided Revascularization in Acute Myocardial Infarction With Multivessel Disease: FRAME-AMI Substudy.

作者信息

Jeon Ho Sung, Lee Jung-Hee, Lee Jun-Won, Youn Young Jin, Lee Joo Myung, Kim Hyun Kuk, Park Keun Ho, Choo Eun Ho, Kim Chan Joon, Lee Seung Hun, Kim Min Chul, Hong Young Joon, Doh Joon-Hyung, Lee Sang Yeub, Park Sang Don, Lee Hyun-Jong, Kang Min Gyu, Koh Jin-Sin, Cho Yun-Kyeong, Nam Chang-Wook, Koo Bon-Kwon, Lee Bong-Ki, Yun Kyeong Ho, Hahn Joo-Yong, Ahn Sung Gyun

机构信息

Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.

Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

Korean Circ J. 2025 May 13. doi: 10.4070/kcj.2024.0430.

DOI:10.4070/kcj.2024.0430

PMID:40628675

Abstract

BACKGROUND AND OBJECTIVES

The prognosis of unrevascularized non-culprit lesions (NCLs) and the benefits of non-culprit percutaneous coronary intervention (PCI) may depend on their functional significance and location in patients with acute myocardial infarction (AMI) and multivessel coronary disease (MVD). We investigated the differential outcomes of fractional flow reserve (FFR) versus angiography-guided PCI for NCL between the left anterior descending artery (LAD) and non-LAD arteries.

METHODS

This was a prespecified post hoc analysis of the FRAME-AMI trial. The primary endpoint, a composite of time to death, myocardial infarction, or repeat revascularization, was matched between the two strategies according to the NCL location.

RESULTS

Among 562 patients, the proportions of NCL in the LAD and non-LAD groups were 55.0% and 45.0%, respectively. PCI rates (82.2% vs. 78.3%; p=0.242) and the primary outcome (9.4% vs. 11.5%; p=0.421) were comparable between the two groups. In the non-culprit LAD group, FFR-guided PCI was associated with a lower rate of the primary outcome compared to angiography-guided PCI (5.7% vs. 14.3%, p=0.010). In the non-culprit non-LAD group, the outcome rate did not significantly differ between FFR- and angiography-guided PCI (7.4% vs. 14.5%, p=0.081). Nevertheless, the interaction between the non-culprit location and FFR- or angiography-guided PCI did not affect the primary outcome (p=0.667).

CONCLUSIONS

The NCL location did not affect the favorable outcomes of FFR-guided PCI over angiography-guided PCI in patients with AMI and MVD.

摘要

背景与目的

在急性心肌梗死（AMI）和多支冠状动脉疾病（MVD）患者中，未行血运重建的非罪犯病变（NCLs）的预后以及非罪犯经皮冠状动脉介入治疗（PCI）的获益可能取决于其功能意义和位置。我们研究了左前降支（LAD）和非LAD动脉之间，分数血流储备（FFR）与血管造影引导的PCI治疗NCL的不同结果。

方法

这是对FRAME-AMI试验进行的一项预先指定的事后分析。根据NCL位置，在两种策略之间匹配主要终点，即死亡、心肌梗死或再次血运重建的时间复合终点。

结果

在562例患者中，LAD组和非LAD组中NCL的比例分别为55.0%和45.0%。两组之间的PCI率（82.2%对78.3%；p=0.242）和主要结局（9.4%对11.5%；p=0.421）具有可比性。在非罪犯LAD组中，与血管造影引导的PCI相比，FFR引导的PCI与较低的主要结局发生率相关（5.7%对14.3%，p=0.010）。在非罪犯非LAD组中，FFR引导和血管造影引导的PCI之间的结局发生率无显著差异（7.4%对14.5%，p=0.081）。然而，非罪犯位置与FFR或血管造影引导的PCI之间的相互作用并未影响主要结局（p=0.667）。