Clinical Relevance of Functionally Insignificant Moderate Coronary Artery Stenosis Assessed by 3-Vessel Fractional Flow Reserve Measurement.
Clinical Relevance of Functionally Insignificant Moderate Coronary Artery Stenosis Assessed by 3-Vessel Fractional Flow Reserve Measurement.
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DOI：
10.1161/jaha.117.008055
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发表时间：
2018-02-15
影响因子：
5.4
通讯作者：
Akasaka T
中科院分区：
文献类型：
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作者：
Park J;Lee JM;Koo BK;Shin ES;Nam CW;Doh JH;Hwang D;Zhang J;Hu X;Wang J;Ye F;Chen S;Yang J;Chen J;Tanaka N;Yokoi H;Matsuo H;Takashima H;Shiono Y;Akasaka T
对多支冠状动脉血管中功能不显著病变所带来的风险的理解是有限的。我们基于3支血管血流储备分数（FFR）研究了冠状动脉疾病（CAD）的预后影响。共有1，136例患者接受了3条主要心外膜动脉的FFR测量。我们将“中度CAD”血管定义为FFR为0.81 - 0.87的血管。患者分为第1组：无明显CAD（所有3支血管的FFR>0.87）;第2组：单支血管中度CAD;第3组：多支血管中度CAD;第4组：任何血管的功能显著CAD（FFR≤0.80）。主要终点为2年主要不良心脏事件，包括心源性死亡、心肌梗死和缺血驱动的血运重建。43%的患者患有中度CAD（第2组：403/1136，35.5%;第3组：84/1136，7.4%）。单支血管中度CAD患者和无明显CAD患者的2年主要不良心脏事件风险无显著差异（2.6 vs 2.6%; HR，1.1; 95%置信区间，0.4%-2.8%; P=0.89）。然而，多支血管中度CAD患者的风险显著高于第1组（7.4 vs 2.6%;风险比，3.3; 95%置信区间，1.1%-9.8%; P=0.03）。多支中度CAD患者的主要不良心脏事件风险与功能显著CAD患者的风险相当（风险比，1.2; 95%置信区间，0.5%-3.0%; P=0.67）。在多变量回归模型中，多支血管中度CAD是2年主要不良心脏事件风险较高的独立预测因素。通过3条血管的FFR测量进行的总体生理评估可以识别多支血管中度CAD。多支中度CAD的预后意义似乎与功能显著的CAD相当。 URL：http://www.clinicaltrials.gov。唯一标识符：NCT 01621438。
Understanding of the risk conferred by functionally insignificant lesions in multiple coronary vessels is limited. We investigated the prognostic implications of coronary artery disease (CAD) based on 3‐vessel fractional flow reserve (FFR). A total of 1,136 patients underwent FFR measurement in the 3 major epicardial arteries. We defined vessels with “Moderate CAD” as vessels with FFR, 0.81 to 0.87. Patients were classified into Group 1: No apparent CAD (FFR>0.87 in all 3‐vessels); Group 2: Single‐vessel moderate CAD; Group 3: Multivessel moderate CAD; and Group 4: Functionally significant CAD (FFR≤0.80) in any vessel. The primary end point was 2‐year major adverse cardiac events, a composite of cardiac death, myocardial infarction, and ischemia‐driven revascularization. Forty‐three percent of patients had moderate CAD (Group 2: 403/1136, 35.5%; Group 3: 84/1136, 7.4%). The 2‐year risk of major adverse cardiac events was not significantly different between patients with single‐vessel moderate CAD and no apparent CAD (2.6 versus 2.6%; HR, 1.1; 95% confidence interval, 0.4%–2.8%; P=0.89). However, patients with multivessel moderate CAD were at significantly higher risk than Group 1 (7.4 versus 2.6%; hazard ratio, 3.3; 95% confidence interval, 1.1%–9.8%; P=0.03). The risk of major adverse cardiac events in patients with multivessel moderate CAD was comparable to that of patients with functionally significant CAD (hazard ratio, 1.2; 95% confidence interval, 0.5%–3.0%; P=0.67). In a multivariable regression model, multivessel moderate CAD was an independent predictor of greater risk of 2‐year major adverse cardiac events. Global physiologic assessment with FFR measurement of 3 vessels can identify multivessel moderate CAD. The prognostic implication of multivessel moderate CAD appears comparable to that of functionally significant CAD. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01621438.