Long-Term Prognosis of Deferred Acute Coronary Syndrome Lesions Based on Nonischemic Fractional Flow Reserve
Long-Term Prognosis of Deferred Acute Coronary Syndrome Lesions Based on Nonischemic Fractional Flow Reserve
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DOI：
10.1016/j.jacc.2016.06.035
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发表时间：
2016-09-01
影响因子：
24
通讯作者：
Uretsky, Barry F.
中科院分区：
文献类型：
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作者：
Hakeem, Abdul;Edupuganti, Mohan M.;Uretsky, Barry F.
根据血流储备分数（FFR）延迟非缺血性病变的经皮冠状动脉介入治疗与稳定性缺血性心脏病（SIHD）患者的良好长期预后相关。尽管血流储备分数越来越多地用于中度病变的急性冠状动脉综合征（ACS）患者的临床决策，它对长期本研究调查了基于非缺血性血流储备分数延迟经皮冠状动脉介入治疗的ACS患者中血流储备分数的临床和预后效用。370例SIHD患者（528处病变），基于非缺血性FFR（>0.75）延迟血运重建。主要结果测量是心肌梗死和靶血管衰竭（主要不良心血管事件[MACE]）的复合物。结果在整个队列中，ACS组的长期（3.4 +/-1.6年）MACE率高于SIHD组（23%vs.11%，p < 0.0001）。倾向评分匹配后（200例患者/组），MACE仍显著较高（ACS 25% vs. SIHD 12%; p < 0.0001）。对MACE进行考克斯比例风险分析，ACS的风险比为2.8（95%置信区间：1.9 - 4.0; p < 0.0001）。在匹配和不匹配队列中，在所有FFR类别中，ACS患者的年心肌梗死/靶血管血运重建率显著高于SIHD（p < 0.05）。接受者操作特征分析确定ACS的FFR临界值（MACE的最佳预测准确度）< 0.84（MACE 21% vs. 36%; p = 0.007），
BACKGROUND Deferring percutaneous coronary intervention in nonischemic lesions by fractional flow reserve (FFR) is associated with excellent long-term prognosis in patients with stable ischemic heart disease (SIHD). Although FFR is increasingly used for clinical decision making in acute coronary syndrome (ACS) patients with intermediate lesions, its effect on long-term prognosis has not been well established.OBJECTIVES This study investigated the clinical and prognostic utility of FFR in ACS patients with percutaneous coronary intervention deferred on the basis of nonischemic FFR.METHODS We studied 206 consecutive ACS patients with 262 intermediate lesions and 370 patients with SIHD (528 lesions) in whom revascularization was deferred on the basis of a nonischemic FFR (>0.75). The primary outcome measure was a composite of myocardial infarction and target vessel failure (major adverse cardiovascular events [MACE]).RESULTS In the entire cohort, the long-term (3.4 +/- 1.6 years) MACE rate was higher in the ACS group than in the SIHD group (23% vs. 11%, p < 0.0001). After propensity score matching (200 patients/group), MACE remained significantly higher (ACS 25% vs. SIHD 12%; p < 0.0001). On Cox proportional hazards analysis for MACE, ACS had a hazard ratio of 2.8 (95% confidence interval: 1.9 to 4.0; p < 0.0001). In both the matched and unmatched cohorts, across all FFR categories, ACS patients had a significantly higher annualized myocardial infarction/target vessel revascularization rate compared with SIHD (p < 0.05). Receiver-operating characteristic analysis identified FFR cutoffs (best predictive accuracy for MACE) of < 0.84 for ACS (MACE 21% vs. 36%; p = 0.007) and