Utilization and Outcomes of Measuring Fractional Flow Reserve in Patients With Stable Ischemic Heart Disease
Utilization and Outcomes of Measuring Fractional Flow Reserve in Patients With Stable Ischemic Heart Disease
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DOI：
10.1016/j.jacc.2019.10.060
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发表时间：
2020-02-04
影响因子：
24
通讯作者：
Fearon, William F.
中科院分区：
文献类型：
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作者：
Parikh, Rushi V.;Liu, Grace;Fearon, William F.
背景血流储备分数（FFR）测量在稳定性缺血性心脏病（SIHD）患者中的应用和临床结果尚不确定，因为先前的研究是基于选定的人群。真实的-血流储备分数使用的世界模式及其对SIHD和血管造影中度狭窄患者预后的影响。临床评估、报告和跟踪（CART）计划，分析在2009年1月1日至2017年9月30日期间接受冠状动脉造影术并患有SIHD伴血管造影中度疾病（目视检查直径狭窄40%至69%）的患者。作者记录了血流储备分数利用率的趋势，并使用广义混合模型评价了预测因子。他们应用考克斯比例风险模型来确定血流储备分数指导的血运重建策略与1年全因死亡率之间的关系。在所有中度病变患者中，FFR使用率从14.8%逐渐增加至18.5%，在接受经皮冠状动脉介入治疗的患者中，FFR使用率从44%逐渐增加至75%。FFR组的1年死亡率为2.8%，仅血管造影组为5.9%（p < 0.0001）。在调整患者、临床试验机构水平和手术因素后，FFR引导的血运重建与仅血管造影血运重建相比，1年时死亡风险降低43%（风险比：0.57; 95%置信区间：0.45至0.71;结论：在SIHD和血管造影中度狭窄的患者中，FFR的使用缓慢增加，并且与显著较低的1年死亡率相关。(C)2020年美国心脏病学会基金会。由Elsevier出版。All rights reserved.
BACKGROUND The use and clinical outcomes of fractional flow reserve (FFR) measurement in patients with stable ischemic heart disease (SIHD) are uncertain, as prior studies have been based on selected populations.OBJECTIVES This study sought to evaluate contemporary, real-world patterns of FFR use and its effect on outcomes among unselected patients with SIHD and angiographically intermediate stenoses.METHODS The authors used data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) Program to analyze patients who underwent coronary angiography between January 1, 2009, and September 30, 2017, and had SIHD with angiographically intermediate disease (40% to 69% diameter stenosis on visual inspection). The authors documented trends in FFR utilization and evaluated predictors using generalized mixed models. They applied Cox proportional hazards models to determine the association between an FFR-guided revascularization strategy and all-cause mortality at 1 year.RESULTS A total of 17,989 patients at 66 sites were included. The rate of FFR use gradually increased from 14.8% to 18.5% among all patients with intermediate lesions, and from 44% to 75% among patients who underwent percutaneous coronary intervention. One-year mortality was 2.8% in the FFR group and 5.9% in the angiography-only group (p < 0.0001). After adjustment for patient, site-level, and procedural factors, FFR-guided revascularization was associated with a 43% lower risk of mortality at 1 year compared with angiography-only revascularization (hazard ratio: 0.57; 95% confidence interval: 0.45 to 0.71; p < 0.0001).CONCLUSIONS In patients with SIHD and angiographically intermediate stenoses, use of FFR has slowly risen, and was associated with significantly lower 1-year mortality. (C) 2020 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.