FAVOR III China: quantitative flow ratio-guided coronary intervention in practice.
FAVOR III China: quantitative flow ratio-guided coronary intervention in practice.
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FAVOR III 中国：定量血流比引导冠状动脉介入治疗的实践。
DOI：
10.1093/cvr/cvac109
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发表时间：
2022
影响因子：
10.8
通讯作者：
Ang D
中科院分区：
文献类型：
--
作者：
Ang D
与单独的血管造影评估相比，基于压力导丝的血流储备分数（FFR）和瞬时无波比率（iFR）生理评估更准确地识别血流限制性病变。因此，国际指南推荐它们来帮助决定血运重建。1，2在病变评估期间结合FFR数据改变了心导管实验室的血运重建决策。3重要的是，它可以改善慢性4和急性冠状动脉综合征的预后。5然而，在临床实践中，采用有创生理测量仍然有限。这部分是由冠状动脉仪器的需求、增加的手术时间和成本驱动的。因此，对作为血管造影术的辅助的非侵入性生理测量的兴趣越来越大。一般来说，这些技术是通过基于伯努利和/或泊氏定律的计算建模和流动动力学来计算的。6数据可以从CT 7或侵入性冠状动脉造影术中获取。8迄今为止的研究表明，无创指数和有创血流储备分数之间存在可靠的相关性。6在FAST II研究中，Masdjedi等人8证明了基于定量冠状动脉造影的血管FFR在识别侵入性FFR≤ 0.80方面的灵敏度为81%，特异性为95%。与许多其他非侵入性指标类似，使用中央核心实验室上传和分析血管造影数据迄今为止限制了其在临床实践中的实时效用。Morris等人6总结了最近基于血管造影术的生理评估技术，沿着了其潜在缺陷。在此背景下，Xu等人9提供了来自FAVOR III中国试验的新数据，该试验旨在确定围手术期使用定量血流比（QFR）指导经皮冠状动脉介入治疗（PCI）的病变选择是否可以改善临床结局（与单独使用血管造影引导相比）。这项由药物发起的、多中心、设盲、随机、假对照试验于2018年12月25日至2020年1月19日期间入组了来自中国26个中心的3847例患者。筛选前年龄≥ 18岁、患有慢性冠状动脉综合征或心肌梗死≥ 72小时、冠状动脉参考直径≥ 2.5 mm、有≥ 1处直径狭窄50-90%的病变的患者符合资格。主要排除标准为中度或重度慢性肾脏疾病（定义为肌酐> 150 μmol/L或估计的肾小球滤过率< 45 mL/kg/173 m2）、重度血管迂曲、血管重叠或用于QFR测定的次优血管造影图像。n= 22例患者选择不接受PCI，或由主治医生退出。
Pressure wire-based physiological assessment with fractional flow reserve (FFR) and the instantaneous wave-free ratio (iFR) more accurately identifies flow-limiting lesions than angiographic assessment alone. As such, they are recommended by international guidelines to aid decisions on revascularization. 1, 2 Incorporation of FFR data during lesion assessment alters revascularization decisions in the cardiac catheterization laboratory. 3 Importantly, it may lead to improved prognosis in chronic 4 and acute coronary syndromes. 5However, the adoption of invasive physiological measurements remains limited in clinical practice. This is partially driven by the need for coronary instrumentation, increased procedural time and cost. As such, there is increasing interest in non-invasive physiological measurements as an adjunct to angiography. In general, these techniques are calculated by computational modelling and flow dynamics based on the laws of Bernoulli and/or Poiseuille. 6 Data can be acquired from either CT 7 or invasive coronary angiography. 8 Studies so far have shown reliable correlation between non-invasive indices and invasive FFR. 6 In the FAST II study, Masdjedi et al. 8 demonstrated a 81% sensitivity and 95% specificity of quantitative coronary angiography-based vessel FFR in identifying an invasive FFR≤ 0.80. Akin to many other non-invasive indices, the upload and analysis of angiographic data using a central core-lab have thus far limited its real-time utility in clinical practice. Morris et al. 6 provided a summary of recent angiographybased physiological assessment techniques, along with their potential pitfalls. Within this context, Xu et al. 9 provide new data from the FAVOR III China trial, which sought to determine whether the peri-procedural use of quantitative flow ratio (QFR) to guide lesion selection for percutaneous coronary intervention (PCI) might improve clinical outcomes, compared with angiography-guidance alone. This investigator-initiated, multicentre, blinded, randomized, sham-controlled trial enrolled 3847 patients from 26 centres in China between 25/12/2018 and 19/01/2020. Patients aged≥ 18 years with chronic coronary syndromes or myocardial infarction≥ 72 h before screening, who had≥ 1 lesion with diameter stenosis 50–90% in a coronary artery≥ 2.5 mm reference diameter were eligible. The main exclusion criteria were moderate or severe chronic kidney disease (defined as creatinine> 150 μmol/L or estimated glomerular filtration rate< 45 mL/kg/173 m2), severe vessel tortuosity, vessel overlap, or suboptimal angiographic images for QFR determination. n= 22 patients elected to not undergo PCI, or were withdrawn by the treating physicians.
影响因子：
39.3
作者：
Layland J;Oldroyd KG;Curzen N;Sood A;Balachandran K;Das R;Junejo S;Ahmed N;Lee MM;Shaukat A;O'Donnell A;Nam J;Briggs A;Henderson R;McConnachie A;Berry C;FAMOUS–NSTEMI investigators
通讯作者：
FAMOUS–NSTEMI investigators