Prognostic Value of Fractional Flow Reserve Linking Physiologic Severity to Clinical Outcomes

被引：491

作者：

Johnson, Nils P. ^{[1
,2
]}

Toth, Gabor G. ^{[3
]}

Lai, Dejian ^{[4
]}

Zhu, Hongjian ^{[4
]}

Acar, Goksel ^{[5
]}

Agostoni, Pierfrancesco ^{[6
]}

Appelman, Yolande ^{[7
]}

Arslan, Fatih ^{[6
]}

Barbato, Emanuele ^{[3
]}

Chen, Shao-Liang ^{[8
]}

Di Serafino, Luigi ^{[9
]}

Dominguez-Franco, Antonio J. ^{[10
]}

Dupouy, Patrick ^{[11
]}

Esen, Ali M. ^{[5
]}

Esen, Ozlem B. ^{[12
]}

Hamilos, Michalis ^{[13
]}

Iwasaki, Kohichiro ^{[14
]}

Jensen, Lisette O. ^{[15
]}

Jimenez-Navarro, Manuel F. ^{[10
]}

Katritsis, Demosthenes G. ^{[16
]}

Kocaman, Sinan A. ^{[17
]}

Koo, Bon-Kwon ^{[18
]}

Lopez-Palop, Ramon ^{[19
]}

Lorin, Jeffrey D. ^{[20
]}

Miller, Louis H. ^{[21
]}

Muller, Olivier ^{[22
]}

Nam, Chang-Wook ^{[23
]}

Oud, Niels ^{[7
]}

Puymirat, Etienne ^{[24
]}

Rieber, Johannes ^{[25
]}

Rioufol, Gilles ^{[26
,27
]}

Rodes-Cabau, Josep ^{[28
]}

Sedlis, Steven P. ^{[20
]}

Takeishi, Yasuchika ^{[29
]}

Tonino, Pim A. L. ^{[30
,31
]}

Van Belle, Eric ^{[32
,33
]}

Verna, Edoardo ^{[34
]}

Werner, Gerald S. ^{[35
]}

Fearon, William F. ^{[36
]}

Pijls, Nico H. J. ^{[30
,31
]}

De Bruyne, Bernard ^{[3
]}

Gould, K. Lance ^{[1
,2
]}

机构：

[1] Univ Texas Houston, Sch Med, Weatherhead PET Ctr Preventing & Reversing Athero, Dept Med,Div Cardiol, Houston, TX 77030 USA

[2] Mem Hermann Hosp, Houston, TX USA

[3] Cardiovasc Ctr Aalst, Aalst, Belgium

[4] Univ Texas Houston, Sch Publ Hlth, Div Biostat, Houston, TX 77030 USA

[5] Kartal Kosuyolu High Special Educ & Res Hosp, Dept Cardiol, Istanbul, Turkey

[6] Univ Med Ctr Utrecht, Dept Cardiol, Utrecht, Netherlands

[7] Vrije Univ Amsterdam, Med Ctr, Dept Cardiol, Amsterdam, Netherlands

[8] Nanjing Med Univ, Nanjing Hosp 1, Dept Cardiol, Nanjing, Jiangsu, Peoples R China

[9] Presidio Osped PO Venere, Dept Cardiol, Bari, Italy

[10] Univ Malaga, Inst Invest Biomed Malaga IBIMA, Hosp Clin Univ Virgen Victoria, Unidad Gest Clin Corazon, E-29071 Malaga, Spain

[11] Hop Prive DAntony, Antony, France

[12] Mem Hosp, Dept Cardiol, Istanbul, Turkey

[13] Univ Hosp Herakl, Dept Cardiol, Iraklion, Greece

[14] Okayama Kyokuto Hosp, Dept Cardiol, Okayama, Japan

[15] Odense Univ Hosp, Dept Cardiol, DK-5000 Odense, Denmark

[16] Athens Euroclin, Dept Cardiol, Athens, Greece

[17] Gazi Univ, Sch Med, Dept Cardiol, Ankara, Turkey

[18] Seoul Natl Univ Hosp, Dept Internal Med, Seoul 110744, South Korea

[19] Hosp Univ San Juan, Secc Cardiol, Alicante, Spain

[20] NYU, Sch Med, VA New York Harbor Hlth Care Syst, New York, NY USA

[21] NYU, Dept Med, Sch Med, Div Cardiol, New York, NY 10016 USA

[22] Univ Lausanne, Ctr Hosp, CHUV, Dept Cardiol, Lausanne, Switzerland

[23] Keimyung Univ, Dongsan Med Ctr, Dept Internal Med, Taegu, South Korea

[24] Hop Europeen Georges Pompidou, Paris, France

[25] Klinikum Bogenhausen, Clin Cardiol & Internal Intens Care Med, Munich, Germany

[26] Hosp Civils Lyon, Intervent Cardiol Dept, Lyon, France

[27] CARMEN, INSERM 1060, Lyon, France

[28] Univ Laval, Quebec Heart & Lung Inst, Quebec City, PQ, Canada

[29] Fukushima Med Univ, Dept Cardiol & Hematol, Fukushima, Japan

[30] Catharina Hosp, Dept Cardiol, Eindhoven, Netherlands

[31] Eindhoven Univ Technol, Dept Biomed Engn, NL-5600 MB Eindhoven, Netherlands

[32] Univ Hosp, Dept Cardiol, Lille, France

[33] Univ Lille 2, EA2693, Lille, France

[34] Univ Hosp, Osped Circolo & Fdn Macchi, Dept Cardiol, Varese, Italy

[35] Klinikum Darmstadt, Darmstadt, Germany

[36] Stanford Univ, Med Ctr, Div Cardiovasc Med, Stanford, CA 94305 USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2014年 / 64卷 / 16期

关键词：

fractional flow reserve; meta-analysis; prognosis; threshold; PERCUTANEOUS CORONARY INTERVENTION; COLLATERAL BLOOD-FLOW; ARTERY-DISEASE; INTRAVASCULAR ULTRASOUND; STENOSIS SEVERITY; NATURAL-HISTORY; MEDICAL THERAPY; FOLLOW-UP; ANGIOGRAPHY; REVASCULARIZATION;

D O I：

10.1016/j.jacc.2014.07.973

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Fractional flow reserve (FFR) has become an established tool for guiding treatment, but its graded relationship to clinical outcomes as modulated by medical therapy versus revascularization remains unclear. OBJECTIVES The study hypothesized that FFR displays a continuous relationship between its numeric value and prognosis, such that lower FFR values confer a higher risk and therefore receive larger absolute benefits from revascularization. METHODS Meta-analysis of study- and patient-level data investigated prognosis after FFR measurement. An interaction term between FFR and revascularization status allowed for an outcomes-based threshold. RESULTS A total of 9,173 (study-level) and 6,961 (patient-level) lesions were included with a median follow-up of 16 and 14 months, respectively. Clinical events increased as FFR decreased, and revascularization showed larger net benefit for lower baseline FFR values. Outcomes-derived FFR thresholds generally occurred around the range 0.75 to 0.80, although limited due to confounding by indication. FFR measured immediately after stenting also showed an inverse relationship with prognosis (hazard ratio: 0.86, 95% confidence interval: 0.80 to 0.93; p < 0.001). An FFR-assisted strategy led to revascularization roughly half as often as an anatomy-based strategy, but with 20% fewer adverse events and 10% better angina relief. CONCLUSIONS FFR demonstrates a continuous and independent relationship with subsequent outcomes, modulated by medical therapy versus revascularization. Lesions with lower FFR values receive larger absolute benefits from revascularization. Measurement of FFR immediately after stenting also shows an inverse gradient of risk, likely from residual diffuse disease. An FFR-guided revascularization strategy significantly reduces events and increases freedom from angina with fewer procedures than an anatomy-based strategy. (C) 2014 by the American College of Cardiology Foundation.

引用

页码：1641 / 1654

页数：14

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