Deferred vs. performed revascularization for coronary stenosis with grey-zone fractional flow reserve values: data from the IRIS-FFR registry
Deferred vs. performed revascularization for coronary stenosis with grey-zone fractional flow reserve values: data from the IRIS-FFR registry
复制标题
DOI：
10.1093/eurheartj/ehy079
复制
发表时间：
2018-05-07
影响因子：
39.3
通讯作者：
Park, Seung-Jung
中科院分区：
文献类型：
--
作者：
Kang, Do-Yoon;Ahn, Jung-Min;Park, Seung-Jung
目的：血运重建的最佳血流储备分数（FFR）截止值存在争议。我们评估了预后延迟和进行血运重建冠状动脉狭窄与FFR值在灰色区域（0.75-0.80）。方法和结果本研究包括1334例自体冠状动脉狭窄与灰色区域FFR值在1334例患者的前瞻性多中心介入心脏病学研究合作协会血流储备分数注册。683例患者延迟血运重建（延迟组），651例患者进行血运重建（进行组）。55例患者的主要结局为死亡、靶血管心肌梗死（MI）和靶血管血运重建（TVR）的复合终点。延期组中有8.1%的患者，（8.4%）[校正风险比（aHR）1.05，95%可信区间（CI）0.67-1.66; P = 0.79]，中位随访时间为2.9年（四分位距1.5-4.1年）。两组的总体死亡率和自发性MI无差异（死亡率2.5% vs. 2.0%; aHR 0.82，95% CI 0.34-2.00; P = 0.66;自发性MI 0.7% vs. 0.5%; aHR 1.85，95% CI 0.35-9.75; P = 0.47）。手术组的心肌梗死发生率显著较高（0.7% vs. 3.2%; aHR 0.27，95% CI 0.09-0.80; P = 0.02），主要是因为围手术期MI风险较高。延迟组的靶血管血运重建率显著高于延迟组（5.7% vs. 3.7%; aHR 2.17，95% CI 1.17-4.02; P = 0.01）。采用血运重建的围手术期MI的较高可能性被采用延迟的TVR的较高可能性抵消。
Aims The optimal fractional flow reserve (FFR) cut-off value for revascularization is debated. We evaluated the prognosis for deferred and performed revascularization in coronary stenosis with FFR values in the grey zone (0.75-0.80).Methods and results This study included 1334 native coronary stenosis with grey-zone FFR values in 1334 patients from the prospective multicentre Interventional Cardiology Research In-cooperation Society Fractional Flow Reserve registry. Revascularization was deferred for 683 patients (deferred group) and performed for 651 (performed group). The primary outcome, a composite of death, target-vessel myocardial infarction (MI), and target vessel revascularization (TVR) occurred in 55 (8.1%) patients in the deferred group and 55 (8.4%) in the performed group [adjusted hazard ratio (aHR) 1.05, 95% confidence interval (CI) 0.67-1.66; P = 0.79] during a median follow-up of 2.9 years (interquartile range 1.5-4.1 years). Overall mortality and spontaneous MI did not differ between the groups (mortality 2.5% vs. 2.0%; aHR 0.82, 95% CI 0.34-2.00; P = 0.66; spontaneous MI 0.7% vs. 0.5%; aHR 1.85, 95% CI 0.35-9.75; P = 0.47). Myocardial infarction was significantly higher in the performed group (0.7% vs. 3.2%; aHR 0.27, 95% CI 0.09-0.80; P = 0.02) mainly because of a higher risk of periprocedural MI. Target vessel revascularization was significantly higher in the deferred group (5.7% vs. 3.7%; aHR 2.17, 95% CI 1.17-4.02; P = 0.01).Conclusion For coronary stenosis with grey-zone FFR, revascularization was not associated with better clinical outcomes. The higher likelihood of periprocedural MI with revascularization was offset by the higher likelihood of TVR with deferral.