法国乔治•蓬皮杜欧洲医院Etienne Puymirat团队比较了FFR或血管造影引导下多支PCI治疗心肌梗死的疗效。2021年5月16日，《新英格兰医学杂志》发表了该成果。

对于ST段抬高型心肌梗死（STEMI）合并多支病变的患者，经皮冠状动脉介入治疗（PCI）非冠状动脉病变（完全血运重建）优于单纯治疗原发病变。然而，血流储备分数（FFR）引导下的完全血运重建术是否优于血管造影引导下的手术尚不清楚。

研究组进行了一项多中心试验，招募ST段抬高型心肌梗死（STEMI）和多支血管病变患者，将其随机分组，分别接受FFR引导或血管造影引导下接受梗死相关动脉PCI治疗。主要结局是全因死亡、非致命性心肌梗死或1年内导致紧急血运重建的计划外住院。

FFR引导组中每位患者非慢性病变放置的支架数量平均为1.01个，血管造影引导组为1.5个。随访期间，FFR引导组586例患者中有32例（5.5%）发生主要结局事件，血管造影引导组577例患者中有24例（4.2%），风险比为1.32。FFR引导组死亡9例（1.5%），血管造影引导组死亡10例（1.7%）；两组非致死性心肌梗死分别为18例（3.1%）和10例（1.7%）；意外住院导致紧急血运重建分别为15例（2.6%）和11例（1.9%）。

研究结果表明，对于接受完全血运重建的ST段抬高型心肌梗死患者，FFR引导策略在1年内死亡、心肌梗死或紧急血运重建的风险方面并未显著优于血管造影引导策略。

附：英文原文

Title: Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction | NEJM

Author: Etienne Puymirat, M.D., Ph.D.,, Guillaume Cayla, M.D., Ph.D.,, Tabassome Simon, M.D., Ph.D.,, Philippe G. Steg, M.D.,, Gilles Montalescot, M.D., Ph.D.,, Isabelle Durand-Zaleski, M.D., Ph.D.,, Alicia le Bras, M.D.,, Romain Gallet, M.D., Ph.D.,, Khalife Khalife, M.D.,, Jean-Franois Morelle, M.D.,, Pascal Motreff, M.D., Ph.D.,, Gilles Lemesle, M.D., Ph.D.,, Jean-Guillaume Dillinger, M.D., Ph.D.,, Thibault Lhermusier, M.D., Ph.D.,, Johanne Silvain, M.D., Ph.D.,, Vincent Roule, M.D., Ph.D.,, Jean-Noel Labèque, M.D.,, Grégoire Rangé, M.D.,, Grégory Ducrocq, M.D., Ph.D.,, Yves Cottin, M.D.,, Didier Blanchard, M.D.,, Anas Charles Nelson, N.D.,, Bernard De Bruyne, M.D., Ph.D.,, Gilles Chatellier, M.D.,, and Nicolas Danchin, M.D.

Issue&Volume: 2021-05-16

Abstract:

Background

In patients with ST-elevation myocardial infarction (STEMI) who have multivessel disease, percutaneous coronary intervention (PCI) for nonculprit lesions (complete revascularization) is superior to treatment of the culprit lesion alone. However, whether complete revascularization that is guided by fractional flow reserve (FFR) is superior to an angiography-guided procedure is unclear.

Methods

In this multicenter trial, we randomly assigned patients with STEMI and multivessel disease who had undergone successful PCI of the infarct-related artery to receive complete revascularization guided by either FFR or angiography. The primary outcome was a composite of death from any cause, nonfatal myocardial infarction, or unplanned hospitalization leading to urgent revascularization at 1 year.

Results

The mean (±SD) number of stents that were placed per patient for nonculprit lesions was 1.01±0.99 in the FFR-guided group and 1.50±0.86 in the angiography-guided group. During follow-up, a primary outcome event occurred in 32 of 586 patients (5.5%) in the FFR-guided group and in 24 of 577 patients (4.2%) in the angiography-guided group (hazard ratio, 1.32; 95% confidence interval, 0.78 to 2.23; P=0.31). Death occurred in 9 patients (1.5%) in the FFR-guided group and in 10 (1.7%) in the angiography-guided group; nonfatal myocardial infarction in 18 (3.1%) and 10 (1.7%), respectively; and unplanned hospitalization leading to urgent revascularization in 15 (2.6%) and 11 (1.9%), respectively.

Conclusions

In patients with STEMI undergoing complete revascularization, an FFR-guided strategy did not have a significant benefit over an angiography-guided strategy with respect to the risk of death, myocardial infarction, or urgent revascularization at 1 year. However, given the wide confidence intervals for the estimate of effect, the findings do not allow for a conclusive interpretation.

DOI: 10.1056/NEJMoa2104650

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2104650