Abstract：
BACKGROUND: The prognostic impact of complete coronary revascularization relative to non-invasive testing methods is unknown.
OBJECTIVE: To assess the association between completeness of revascularization defined by CTA-derived fractional flow reserve (FFRCT) and cardiovascular outcomes in patients with stable angina.
METHODS: Multicenter 3-year follow-up study of patients with new onset stable angina and ≥ 30% stenosis by CTA. The lesion-specific FFRCT value (two cm-distal-to-stenosis) was registered in all vessels with stenosis and considered abnormal when ≤ 0.80. Patients with FFRCT ≤ 0.80 were categorized as: Completely revascularized (CR-FFRCT), all vessels with FFRCT ≤ 0.80 revascularized; incompletely revascularized (IR-FFRCT), ≥ 1 vessels with FFRCT ≤ 0.80 non-revascularized. Early revascularization (< 90 days from index CTA) categorized vessels as revascularized. The primary endpoint comprised cardiovascular death and non-fatal myocardial infarction; the secondary endpoint vessel-specific late revascularization and non-fatal myocardial infarction.
RESULTS: Amongst 900 patients and 1759 vessels, FFRCT was ≤ 0.80 in 377 (42%) patients, 536 (30%) vessels; revascularization was performed in 244 (27%) patients, 340 (19%) vessels. Risk of the primary endpoint was higher for IR-FFRCT (15/210 [7.1%]) compared to CR-FFRCT (4/167 [2.4%]), RR: 2.98; 95% CI: 1.01-8.8, p = 0.036, and to normal FFRCT (3/523 [0.6%]), RR: 12.45; 95% CI: 3.6-42.6, p < 0.001. Incidence of the secondary endpoint was higher in non-revascularized vessels with FFRCT ≤ 0.80 (29/250 [12%]) compared to revascularized vessels with FFRCT ≤ 0.80 (5/286 [1.7%]), p = 0.001, and to vessels with FFRCT > 0.80 (10/1223 [0.8%]), p < 0.001.
CONCLUSIONS: Incomplete revascularization of patients with lesion-specific FFRCT ≤ 0.80 is associated to unfavorable cardiovascular outcomes compared to those with complete revascularization or FFRCT > 0.80.
OBJECTIVE: To assess the association between completeness of revascularization defined by CTA-derived fractional flow reserve (FFRCT) and cardiovascular outcomes in patients with stable angina.
METHODS: Multicenter 3-year follow-up study of patients with new onset stable angina and ≥ 30% stenosis by CTA. The lesion-specific FFRCT value (two cm-distal-to-stenosis) was registered in all vessels with stenosis and considered abnormal when ≤ 0.80. Patients with FFRCT ≤ 0.80 were categorized as: Completely revascularized (CR-FFRCT), all vessels with FFRCT ≤ 0.80 revascularized; incompletely revascularized (IR-FFRCT), ≥ 1 vessels with FFRCT ≤ 0.80 non-revascularized. Early revascularization (< 90 days from index CTA) categorized vessels as revascularized. The primary endpoint comprised cardiovascular death and non-fatal myocardial infarction; the secondary endpoint vessel-specific late revascularization and non-fatal myocardial infarction.
RESULTS: Amongst 900 patients and 1759 vessels, FFRCT was ≤ 0.80 in 377 (42%) patients, 536 (30%) vessels; revascularization was performed in 244 (27%) patients, 340 (19%) vessels. Risk of the primary endpoint was higher for IR-FFRCT (15/210 [7.1%]) compared to CR-FFRCT (4/167 [2.4%]), RR: 2.98; 95% CI: 1.01-8.8, p = 0.036, and to normal FFRCT (3/523 [0.6%]), RR: 12.45; 95% CI: 3.6-42.6, p < 0.001. Incidence of the secondary endpoint was higher in non-revascularized vessels with FFRCT ≤ 0.80 (29/250 [12%]) compared to revascularized vessels with FFRCT ≤ 0.80 (5/286 [1.7%]), p = 0.001, and to vessels with FFRCT > 0.80 (10/1223 [0.8%]), p < 0.001.
CONCLUSIONS: Incomplete revascularization of patients with lesion-specific FFRCT ≤ 0.80 is associated to unfavorable cardiovascular outcomes compared to those with complete revascularization or FFRCT > 0.80.
摘要：
背景：完全冠状动脉血运重建相对于非侵入性检测方法的预后影响尚不清楚。
目的：评估由CTA衍生的血流储备分数（FFRCT）定义的血运重建的完整性与稳定型心绞痛患者心血管结局之间的关系。
方法：通过CTA对新发作的稳定型心绞痛和≥30％狭窄的患者进行多中心3年随访研究。在所有狭窄的血管中记录了病变特异性FFRCT值（狭窄远端2cm），当≤0.80时被认为是异常的。FFRCT≤0.80的患者分为：完全血运重建（CR-FFRCT），所有FFRCT≤0.80血管重建；未完全血管重建（IR-FFRCT），FFRCT≤0.80的≥1条血管未血管重建。早期血运重建(CTA指数<90天)将血管分类为血运重建。主要终点包括心血管死亡和非致死性心肌梗死；次要终点血管特异性晚期血运重建和非致死性心肌梗死。
结果：在900名患者和1759条血管中，377例（42%）患者的FFRCT≤0.80，536（30％）血管；244（27％）患者进行了血运重建，340（19%）船。与CR-FFRCT（4/167[2.4%]）相比，IR-FFRCT（15/210[7.1%]）的主要终点风险更高，RR：2.98；95%CI：1.01-8.8，p=0.036，达到正常FFRCT（3/523[0.6%]），RR：12.45；95%CI：3.6-42.6，p<0.001。与FFRCT≤0.80（29/250[12%]）的非血运重建血管相比，FFRCT≤0.80（5/286[1.7%]）的次要终点发生率更高，p=0.001，对于FFRCT>0.80(10/1223[0.8%])的血管，p<0.001。
结论：与完全血运重建或FFRCT>0.80相比，病变特异性FFRCT≤0.80的患者不完全血运重建与不良心血管结局相关。
目的：评估由CTA衍生的血流储备分数（FFRCT）定义的血运重建的完整性与稳定型心绞痛患者心血管结局之间的关系。
方法：通过CTA对新发作的稳定型心绞痛和≥30％狭窄的患者进行多中心3年随访研究。在所有狭窄的血管中记录了病变特异性FFRCT值（狭窄远端2cm），当≤0.80时被认为是异常的。FFRCT≤0.80的患者分为：完全血运重建（CR-FFRCT），所有FFRCT≤0.80血管重建；未完全血管重建（IR-FFRCT），FFRCT≤0.80的≥1条血管未血管重建。早期血运重建(CTA指数<90天)将血管分类为血运重建。主要终点包括心血管死亡和非致死性心肌梗死；次要终点血管特异性晚期血运重建和非致死性心肌梗死。
结果：在900名患者和1759条血管中，377例（42%）患者的FFRCT≤0.80，536（30％）血管；244（27％）患者进行了血运重建，340（19%）船。与CR-FFRCT（4/167[2.4%]）相比，IR-FFRCT（15/210[7.1%]）的主要终点风险更高，RR：2.98；95%CI：1.01-8.8，p=0.036，达到正常FFRCT（3/523[0.6%]），RR：12.45；95%CI：3.6-42.6，p<0.001。与FFRCT≤0.80（29/250[12%]）的非血运重建血管相比，FFRCT≤0.80（5/286[1.7%]）的次要终点发生率更高，p=0.001，对于FFRCT>0.80(10/1223[0.8%])的血管，p<0.001。
结论：与完全血运重建或FFRCT>0.80相比，病变特异性FFRCT≤0.80的患者不完全血运重建与不良心血管结局相关。
