背景:支架置入后血流储备分数(FFR)的预后价值在接受影像学引导下最佳支架置入策略的患者中仍不确定。
目的:作者根据冠状动脉成像引导的病变准备评估支架术后FFR的预后价值,支架尺寸,和扩张后(iPSP)策略,以优化支架的结果。
方法:对来自IRIS-FFR登记的1,005例患者的1,108个病灶进行了支架术后FFR评估。主要结果是目标血管衰竭(TVF),心脏死亡的复合物,靶血管心肌梗死,5年时目标血管血运重建。
结果:在索引过程中,使用iPSP策略的所有3个部分治疗了326个病变(29.4%)。在总人口中,支架置入后FFR与5年的TVF风险显著相关(每增加0.01,调整后的HR[aHR]:0.94;95%CI:0.90-0.98;P=0.004)。在支架置入后FFR和iPSP策略对5年TVF风险之间检测到显著的交互作用(交互作用P=0.045)。在iPSP组中,支架置入后FFR与5年的TVF风险无关(每增加0.01,aHR:1.00;95%CI:0.96-1.05;P=0.95),而支架置入后FFR和TVF在5年观察到显著关联在无iPSPP组(每增加0.01FFR,HR:0.94;95%CI:0.90-0.99;P=0.009)。
结论:支架术后FFR与心脏事件显著相关。然而,在应用影像引导下的最佳支架置入策略后,其预后价值似乎受到限制.
BACKGROUND: Prognostic value of poststenting fractional flow reserve (FFR) remains uncertain in patients undergoing an imaging-guided optimal stenting strategy.
OBJECTIVE: The authors evaluated the prognostic value of poststenting FFR according to the intracoronary imaging-guided lesion preparation, stent sizing, and postdilation (iPSP) strategy to optimize stent outcomes.
METHODS: Poststenting FFR assessment was performed in 1,108 lesions in 1,005 patients from the IRIS-FFR registry. The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization at 5 years.
RESULTS: At the index procedure, 326 lesions (29.4%) were treated using all 3 parts of the iPSP strategy. In the overall population, poststenting FFR was significantly associated with the risk of TVF at 5 years (per 0.01 increase of FFR, adjusted HR [aHR]: 0.94; 95% CI: 0.90-0.98; P = 0.004). Significant interaction was detected between poststenting FFR and the iPSP strategy on the risk of TVF at 5 years (P = 0.045 for interaction). In the iPSP group, poststenting FFR was not associated with the risk of TVF at 5 years (per 0.01 increase of FFR, aHR: 1.00; 95% CI: 0.96-1.05; P = 0.95), whereas a significant association between poststenting FFR and TVF at 5 years was observed in the no iPSP group (per 0.01 increase of FFR, aHR: 0.94; 95% CI: 0.90-0.99; P = 0.009).
CONCLUSIONS: Poststenting FFR showed a significant association with cardiac events. However, its prognostic value appeared to be limited after the application of an imaging-guided optimal stenting strategy.