■尽管经皮冠状动脉介入治疗(PCI)的血管造影结果最佳,罪犯病变部位的残留疾病可导致主要的不良心脏事件。PCI后生理评估可以识别残余狭窄。本荟萃分析旨在研究PCI后生理评估与长期结局相关的研究数据。
■在2022年7月1日进行系统的文献检索后,将研究纳入荟萃分析。主要终点是主要不良心脏事件的发生率,血管定向心脏事件,或目标血管故障。
■PCI术后血流储备分数低,在7项研究中报道,血流储备分数临界值在0.84和0.90之间,包括4017名患者,与主要终点的发生率增加相关(风险比[HR],2.06;95%CI,1.37-3.08)。一项研究报道了PCI术后瞬时无波比率受损,瞬时无波比率截止值为0.95,与主要不良心脏事件有关。显示出显著的关联(HR,3.38;95%CI,0.99-11.6;P=.04)。低PCI术后定量流量比,在3项研究中报道,定量流量比临界值在0.89和0.91之间,包括1181名患者,与血管定向心脏事件发生率增加相关(HR,3.01;95%CI,2.10-4.32)。结合所有模式的数据,受损的生理评估显示主要终点(HR,2.32;95%CI,1.71-3.16)和次要终点,包括死亡(HR,1.41;95%CI,1.04-1.89),心肌梗死(HR,2.70;95%CI,1.34-5.42)和靶血管血运重建(HR,2.88;95%CI,1.91-4.35)。
PCI术后生理评估受损与不良心脏事件和个体终点增加相关,包括死亡,心肌梗塞,和目标血管血运重建。因此,关于基于生理学的PCI优化是否能带来更好的临床结局的前瞻性研究尚待进行。
UNASSIGNED: Despite the optimal angiographic result of percutaneous coronary intervention (PCI), residual disease at the site of the culprit lesion can lead to major adverse cardiac events. Post-PCI physiological assessment can identify residual stenosis. This meta-analysis aims to investigate data of studies examining post-PCI physiological assessment in relation to long-term outcomes.
UNASSIGNED: Studies were included in the meta-analysis after performing a systematic literature search on July 1, 2022. The primary end point was the incidence of major adverse cardiac events, vessel-orientated cardiac events, or target vessel failure.
UNASSIGNED: Low post-PCI fractional flow reserve, reported in 7 studies with fractional flow reserve cutoff values between 0.84 and 0.90, including 4017 patients, was associated with an increased rate of the primary end point (hazard ratio [HR], 2.06; 95% CI, 1.37-3.08). One study reported about impaired post-PCI instantaneous wave-free ratio with instantaneous wave-free ratio cutoff value of 0.95 in relation to major adverse cardiac events, showing a significant association (HR, 3.38; 95% CI, 0.99-11.6; P = .04). Low post-PCI quantitative flow ratio, reported in 3 studies with quantitative flow ratio cutoff value between 0.89 and 0.91, including 1181 patients, was associated with an increased rate of vessel-orientated cardiac events (HR, 3.01; 95% CI, 2.10-4.32). Combining data of all modalities, impaired physiological assessment showed an increased rate of the primary end point (HR, 2.32; 95% CI, 1.71-3.16) and secondary end points, including death (HR, 1.41; 95% CI, 1.04-1.89), myocardial infarction (HR, 2.70; 95% CI, 1.34-5.42) and target vessel revascularization (HR, 2.88; 95% CI, 1.91-4.35).
UNASSIGNED: Impaired post-PCI physiological assessment is associated with increased adverse cardiac events and individual end points, including death, myocardial infarction, and target vessel revascularization. Therefore, prospective studies are awaited on whether physiology-based optimization of PCI results in better clinical outcomes.