加拿大多伦多大学Dennis T. Ko团队研究了冠心病患者遵循血流储备分数阈值与重大心脏不良事件的相关性。2020年11月13日，该研究发表在《美国医学会杂志》上。

血流储备分数（FFR）是一种有创测量方法，用于评估冠脉狭窄诱发心肌缺血的可能性，并指导经皮冠脉介入治疗（PCI）的决策。目前尚不清楚常规介入实践中是否遵守PCI的FFR阈值，以及遵守这些阈值是否与更好的临床预后有关。

为了评估PCI遵循FFR阈值的依从性及其与临床预后的关系，2013年4月1日至2018年3月31日，研究组在加拿大安大略省进行了一项单支血管FFR评估（不包括st段抬高型心肌梗死）的回顾性、多中心、以人群为基础的队列研究，并随访至2019年3月31日。基于FFR阈值（≤0.80为缺血性，>0.80为非缺血性），研究组创建了两个独立队列。主要结局为重大心脏不良事件（MACE），定义为死亡、心肌梗塞、不稳定型心绞痛或紧急冠脉血运重建。

共有9106例患者接受了单支血管FFR检测，平均年龄为65岁，女性占35.3％。在2693例缺血性FFR患者中，有75.3％接受了PCI，24.7％接受了药物治疗。在缺血性FFR队列中，PCI组5年MACE的发生率为31.5%，显著低于无PCI组（39.1%），风险比为0.77。在6413例非缺血性FFR患者中，有12.6％接受了PCI，87.4％接受了药物治疗。PCI组5年MACE的发生率为33.3%，显著高于无PCI组（24.4%）。

研究结果表明，对于在常规临床实践中进行单支血管FFR测量的冠心病患者，接受PCI与不进行PCI相比，缺血性病变的MACE发生率较低，非缺血性病变的MACE发生率较高。

附：英文原文

Title: Association Between Adherence to Fractional Flow Reserve Treatment Thresholds and Major Adverse Cardiac Events in Patients With Coronary Artery Disease

Author: Maneesh Sud, Lu Han, Maria Koh, Peter C. Austin, Michael E. Farkouh, Hung Q. Ly, Mina Madan, Madhu K. Natarajan, Derek Y. So, Harindra C. Wijeysundera, Jiming Fang, Dennis T. Ko

Issue&Volume: 2020-11-13

Abstract:

Importance  Fractional flow reserve (FFR) is an invasive measurement used to assess the potential of a coronary stenosis to induce myocardial ischemia and guide decisions for percutaneous coronary intervention (PCI). It is not known whether established FFR thresholds for PCI are adhered to in routine interventional practice and whether adherence to these thresholds is associated with better clinical outcomes.

Objective  To assess the adherence to evidence-based FFR thresholds for PCI and its association with clinical outcomes.

Design, Setting, and Participants  A retrospective, multicenter, population-based cohort study of adults with coronary artery disease undergoing single-vessel FFR assessment (excluding ST-segment elevation myocardial infarction) from April 1, 2013, to March 31, 2018, in Ontario, Canada, and followed up until March 31, 2019, was conducted. Two separate cohorts were created based on FFR thresholds (≤0.80 as ischemic and >0.80 as nonischemic). Inverse probability of treatment weighting was used to account for treatment selection bias.

Exposures  PCI vs no PCI.

Main Outcomes and Measures  The primary outcome was major adverse cardiac events (MACE) defined by death, myocardial infarction, unstable angina, or urgent coronary revascularization.

Results  There were 9106 patients (mean [SD] age, 65 [10.6] years; 35.3% female) who underwent single-vessel FFR measurement. Among 2693 patients with an ischemic FFR, 75.3% received PCI and 24.7% were treated only with medical therapy. In the ischemic FFR cohort, PCI was associated with a significantly lower rate and hazard of MACE at 5 years compared with no PCI (31.5% vs 39.1%; hazard ratio, 0.77 [95% CI, 0.63-0.94]). Among 6413 patients with a nonischemic FFR, 12.6% received PCI and 87.4% were treated with medical therapy only. PCI was associated with a significantly higher rate and hazard of MACE at 5 years compared with no PCI (33.3% vs 24.4%; HR, 1.37 [95% CI, 1.14-1.65]) in this cohort.

Conclusions and Relevance  Among patients with coronary artery disease who underwent single-vessel FFR measurement in routine clinical practice, performing PCI, compared with not performing PCI, was significantly associated with a lower rate of MACE for ischemic lesions and a higher rate of MACE for nonischemic lesions. These findings support the performance of PCI procedures according to evidence-based FFR thresholds.

DOI: 10.1001/jama.2020.22708

Source: https://jamanetwork.com/journals/jama/fullarticle/2773127