冠状动脉血流储备分数水平与冠心病患者预后的关系

Predictive value of fractional flow reserve measurement on outcome in coronary artery disease

目的:观察在冠心病诊疗中冠状动脉血流储备分数(FFR)对冠心病患者预后的指导价值。方法:本研究为前瞻性、观察性研究。研究纳入389例于北京安贞医院行冠状动脉造影及FFR检测的患者,根据治疗方式和FFR值分为两组:非FFR指导组(FFR≤0.80且药物治疗,n=62)和FFR值指导组(根据FFR值选择标准治疗策略,n=327),后者进一步分为两个亚组:FFR指导介入亚组(FFR≤0.80且PCI,n=134);FFR指导药物亚组(FFR>0.80且药物治疗,n=193)。结果:中位随访时间为24.5个月,非FFR指导组较FFR值指导组主要临床终点发生率,差异无统计学意义(P=0.502),再次血运重建发生率有升高的趋势(P=0.081)。与FFR指导药物亚组比较,FFR指导介入亚组因再发心绞痛再次住院发生率较高(P=0.035),主要不良心血管病事件发生率显著升高(P=0.026)。Kaplan-Meier曲线显示类似结果。本项研究对489支血管进行了FFR测定,随访过程中,有25支检测血管发生了血运重建,4支检测血管为梗死相关血管。行FFR检测的血管中,FFR指导组中的FFR指导药物亚组、FFR指导介入亚组的患者的血运重建率分别是7.6%, 10.6%;非FFR指导治疗组中,FFR值介于0.75~0.8之间和<0.75的患者血运重建率分别是11.1%和22.6%;与FFR指导药物亚组相比,非FFR指导组中FFR<0.75的患者的再次血运重建率发生率有升高的趋势(P=0.064)。结论:FFR值检测在冠心病诊疗的现实世界中对预后具有重要的指导意义。

Objective: The aim is to evaluate outcomes of FFR-guided therapy in Chinese real-world practice. Methods: In this prospective, observational study, 389 patients were enrolled who underwent angiography and FFR measurement in Beijing Anzhen hospital. All patients were divided into two groups: these who received medicine therapy with FFR≤0.80(non-FFR guidance, n=62) and those who underwent treatment based on FFR guidance in accordance with standard practice(FFR guidance, n=327). The latter group was further classified into the FFR guidance with PCI subgroup if FFR≤0.80 followed by PCI(n=134) and the FFR guidance with medicine subgroup if FFR>0.80 followed by medicine therapy(n=193). Results: Median follow-up was 24.5 months. There was little difference in the rate of the major adverse between non-FFR guidance group and FFR guidance group(P=0.502). Non-FFR guidance group was associated with increased crude rate of repeat revascularization(P=0.081). Compared with FFR guidance with medicine subgroup, FFR guidance with PCI subgroup had significantly higher rate of MACCE(P=0.026) and re-hospitalization for angina(P=0.035). Kaplan-Meier curve demonstrated the similar result. In the all cohort, 489 vessels were successfully measured, of which 25 vessels suffered repeat revascularization and 4 suffered MI. The rate of repeat revascularization in the FFR guidance with medicine patients’ vessels, FFR guidance with PCI patients’ vessels, FFR between 0.75 and 0.8 patients’ vessels and FFR<0.75 patients’ vessels in non-FFR guidance group was 7.6%, 10.6%, 11.1% and 22.6%, respectively. A non-significantly higher rate of repeat revascularization has been demonstrated in the last group vessels compared with the FFR guidance with medicine patients’ vessels(P=0.064). Conclusions: It is of importance of prognosis to measure FFR in the real world practice for coronary artery intervention.