Usefulness of Fractional Flow Reserve to Improve Diagnostic Efficiency in Patients With Non-ST Elevation Myocardial Infarction
Usefulness of Fractional Flow Reserve to Improve Diagnostic Efficiency in Patients With Non-ST Elevation Myocardial Infarction
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DOI：
10.1016/j.amjcard.2012.08.046
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发表时间：
2013-01-01
影响因子：
2.8
通讯作者：
Berry, Colin
中科院分区：
文献类型：
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作者：
Carrick, David;Behan, Miles;Berry, Colin
心肌血流储备分数 (FFR) 对于病情稳定的非 ST 段抬高型心肌梗死 (NSTEMI) 患者具有新兴的临床实用性和预后价值。本研究的目的是探讨与单独冠状动脉造影相比，测量 FFR 是否可以提高 NSTEMI 患者的诊断效率。纳入了 100 名连续患有 NSTEMI 的患者，这些患者之前接受过临床指示的 FFR 测量。在模拟决策练习中，5名介入心脏病专家回顾性、独立地审查了每位患者的临床病史和冠状动脉造影，然后做出治疗决策。随后公布了 FFR 结果，并要求同一位心脏病专家审查他们最初的治疗决定。 p 值 < 0.05 表示心脏病专家之间存在差异。最初分配到每种治疗方案的患者比例在 5 名心脏病专家之间有所不同 (p = 0.0061)。所有 FFR 测量中 42% 是在罪魁祸首病变处进行的。 FFR 披露后，每位心脏病专家独立做出的治疗决定一致的患者数量（因此代表了 5 名心脏病专家中≥3 名的大多数）从 65% 增加到 91% (p = 0.0094)。 FFR 披露后，心脏病专家改变了 46% 患者的初始治疗计划 (p = 0.0016)。 24% 的患者转而支持药物治疗 (p = 0.0016)，这种增加与“延期”治疗 (p = 0.0067)、单支经皮冠状动脉介入治疗 (p = 0.0052) 和多支经皮冠状动脉介入治疗 (p = 0.046) 的减少有关。总之，FFR 测量减少了诊断变异性，并改变了心脏病专家对 NSTEMI 患者的治疗决策。 (c) 2013 Elsevier Inc. 保留所有权利。 (Am J Cardiol 2013；111:45-50)
Myocardial fractional flow reserve (FFR) has emerging clinical utility and prognostic value in medically stabilized patients with non-ST-segment elevation myocardial infarction (NSTEMI). The aim of this study was to investigate whether measurement of FFR compared to coronary angiography alone improves diagnostic efficiency in patients with NSTEMIs. One hundred consecutive patients with NSTEMIs who had previously undergone clinically indicated FFR measurements were included. In a simulated decision exercise, 5 interventional cardiologists retrospectively and independently reviewed the clinical history and coronary angiogram of each patient and then made a treatment decision. FFR results were then disclosed, and the same cardiologists were asked to review their initial treatment decisions. A p value < 0.05 indicates a difference between cardiologists. The proportion of patients allocated to each treatment option initially differed among the 5 cardiologists (p = 0.0061). Forty-two percent of all FFR measurements were made in culprit lesions. After FFR disclosure, the number of patients in whom the treatment decisions made by each cardiologist independently conformed (and so represented the majority with >= 3 of the 5 cardiologists) increased from 65% to 91% (p = 0.0094). After FFR disclosure, the cardiologists changed their initial treatment plans in 46% of patients (p = 0.0016). Changes in favor of medical therapy occurred in 24% of patients (p = 0.0016), and this increase was associated with reductions in "deferred" management (p = 0.0067), single-vessel percutaneous coronary intervention (p = 0.0052), and multivessel percutaneous coronary intervention (p = 0.046). In conclusion, FFR measurement reduced diagnostic variability and changed cardiologists' treatment decisions for patients with NSTEMIs. (c) 2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;111:45-50)