Background：Fractional flow reserve （FFR） is currently considered as the gold standard for evaluating the functional significance of coronary stenosis.However,its potential benefits in real-world practice remain unk...Background：Fractional flow reserve （FFR） is currently considered as the gold standard for evaluating the functional significance of coronary stenosis.However,its potential benefits in real-world practice remain unknown in China.This study aimed to test the hypothesis that the use of FFR is associated with improved outcome and reduced cost in Chinese real-world clinical practice.Methods：A retrospective cohort study was carried out using the database of Second Affiliated Hospital of Zhejiang University,a tertiary and high-volume center in China.Clinical events were compared using the Cox proportional hazards model during a median follow-up of 13 months.Results：The study cohort consisted of 366 consecutive patients referred for coronary revascularization with adjunct FFR and 366 matched controls,from 2010 to 2014.Major adverse cardiac events （MACEs） （death,myocardial infarction,repeated revascularization,or hospitalization for angina） at 4 years were found in 12.0% ofangiography-guided patients and 4.9% in the FFR-guided group （P 〈 0.001）.The mean number of implanted stents was significantly lower in FFR treated subjects （0.52 ± 0.82 stents） compared with the angiography-guided group （0.93 ± 0.96 stents） （P 〈 0.001）.No difference in overall costs at initial hospitalization was observed between angiography-guided percutaneous coronary intervention （PCI） compared with FFR-guided PCI （RMB 33,000 Yuan,range：RMB 7393-44,700 Yuan） versus RMB 21,200 Yuan （RMB 19,100-47,100 Yuan） （P =0.54）.However,costs for MACEs during follow-up were significantly reduced in the FFR-guided arm （P 〈 0.001）.Conclusions：In the contemporary clinical practice,FFR-guided PCI is associated with decreased use of stents,improved clinical outcome,and reduced costs,compared with angiography-guided PCI.展开更多
Previous studies demonstrated that coronary revascularization,especially percutaneous coronary intervention(PCI),does not significantly decrease the incidence of cardiac death or myocardial infarction in patients with...Previous studies demonstrated that coronary revascularization,especially percutaneous coronary intervention(PCI),does not significantly decrease the incidence of cardiac death or myocardial infarction in patients with stable coronary artery disease.Many studies using myocardial perfusion imaging(MPI) showed that,for patients with moderate to severe ischemia,revascularization is the preferred therapy for survival benefit,whereas for patients with no to mild ischemia,medical therapy is the main choice,and revascularization is associated with increased mortality.There is some evidence that revascularization in patients with no or mild ischemia is likely to result in worsened ischemia,which is associated with increased mortality.Studies using fractional flow reserve(FFR) demonstrate that ischemia-guided PCI is superior to angiography-guided PCI,and the presence of ischemia is the key to decisionmaking for PCI.Complementary use of noninvasive MPI and invasive FFR would be important to compensate for each method's limitations.Recent studies of appropriateness criteria showed that,although PCI in the acute setting and coronary bypass surgery are properly performed in most patients,PCI in the non-acute set-ting is often inappropriate,and stress testing to identify myocardial ischemia is performed in less than half of patients.Also,some studies suggested that revascularization in an inappropriate setting is not associated with improved prognosis.Taken together,the presence and the extent of myocardial ischemia is a key factor in the management of patients with stable coronary artery disease,and coronary revascularization in the absence of myocardial ischemia is associated with worsened prognosis.展开更多
目的:探讨心血管病危险因素对无或轻度冠状动脉(冠脉)狭窄的非血流受限人群的心肌血流量(MBF)及冠脉血流储备(CFR)的影响。方法:回顾性分析在本科室完成13N-氨水正电子发射计算机断层成像(PET)心肌灌注显像(MPI)、冠脉计算机断层摄影术(...目的:探讨心血管病危险因素对无或轻度冠状动脉(冠脉)狭窄的非血流受限人群的心肌血流量(MBF)及冠脉血流储备(CFR)的影响。方法:回顾性分析在本科室完成13N-氨水正电子发射计算机断层成像(PET)心肌灌注显像(MPI)、冠脉计算机断层摄影术(CT)血管造影(CTA)或冠脉造影(CAG)检查提示无或轻度冠脉狭窄的68例受检者,收集整理一般资料(包括年龄、性别、体重指数)及冠心病传统危险因素(糖尿病、高血压、血脂异常、长期吸烟、心血管病家族史)、潜在危险因素(包括阻塞性睡眠呼吸暂停综合征、肿瘤术后化疗后、甲状腺功能亢进症),经绝对定量分析获得静息及负荷MBF、左心室整体CFR。用χ~2检验、二元Logistic回归法分析上述危险因素对心肌灌注的影响。结果:单因素分析发现,男性的负荷MBF低于女性[(3.02±0.72)ml/(min·gm) vs(3.77±0.86)ml/(min·gm),χ~2=3.886,P=0.049],年龄>55岁受试者的CFR最小值(CFRmin)较≤55岁者减低(2.12±0.37 vs2.62±0.67,χ~2=10.236,P=0.001),糖尿病患者CFRmin(2.17±0.44 vs 2.51±0.65,χ~2=5.798,P=0.016)、负荷MBF[(2.79±0.64)ml/(min·gm) vs(3.57±0.86)ml/(min·gm),χ~2=7.053,P=0.008]低于无糖尿病者,存在潜在危险因素人群的CFR平均值(CFRmean)低于无潜在危险因素人群(2.42±0.44 vs 3.30±0.72,P=0.003)。多因素Logistic回归分析结果提示,糖尿病(OR=5.471,95%CI:1.040～28.788)、年龄>55岁(OR=6.213,95%CI:1.758～21.955)是CFRmin减低的危险因素;糖尿病是负荷MBF减低的危险因素(OR=9.444,95%CI:1.912～46.646);潜在危险因素是CFRmean减低的危险因素(OR=18.667,95%CI:2.807～124.145)。结论:(1)心血管病危险因素对静息MBF影响很小;(2)年龄、性别对负荷MBF、CFR有影响;(3)传统心血管病危险因素中,糖尿病对负荷MBF、CFR的影响不容忽视;(4)相比传统心血管病危险因素,潜在危险因素对CFR的影响更为显著,需高度重视,及时纠正或预防。展开更多
文摘Background：Fractional flow reserve （FFR） is currently considered as the gold standard for evaluating the functional significance of coronary stenosis.However,its potential benefits in real-world practice remain unknown in China.This study aimed to test the hypothesis that the use of FFR is associated with improved outcome and reduced cost in Chinese real-world clinical practice.Methods：A retrospective cohort study was carried out using the database of Second Affiliated Hospital of Zhejiang University,a tertiary and high-volume center in China.Clinical events were compared using the Cox proportional hazards model during a median follow-up of 13 months.Results：The study cohort consisted of 366 consecutive patients referred for coronary revascularization with adjunct FFR and 366 matched controls,from 2010 to 2014.Major adverse cardiac events （MACEs） （death,myocardial infarction,repeated revascularization,or hospitalization for angina） at 4 years were found in 12.0% ofangiography-guided patients and 4.9% in the FFR-guided group （P 〈 0.001）.The mean number of implanted stents was significantly lower in FFR treated subjects （0.52 ± 0.82 stents） compared with the angiography-guided group （0.93 ± 0.96 stents） （P 〈 0.001）.No difference in overall costs at initial hospitalization was observed between angiography-guided percutaneous coronary intervention （PCI） compared with FFR-guided PCI （RMB 33,000 Yuan,range：RMB 7393-44,700 Yuan） versus RMB 21,200 Yuan （RMB 19,100-47,100 Yuan） （P =0.54）.However,costs for MACEs during follow-up were significantly reduced in the FFR-guided arm （P 〈 0.001）.Conclusions：In the contemporary clinical practice,FFR-guided PCI is associated with decreased use of stents,improved clinical outcome,and reduced costs,compared with angiography-guided PCI.
文摘Previous studies demonstrated that coronary revascularization,especially percutaneous coronary intervention(PCI),does not significantly decrease the incidence of cardiac death or myocardial infarction in patients with stable coronary artery disease.Many studies using myocardial perfusion imaging(MPI) showed that,for patients with moderate to severe ischemia,revascularization is the preferred therapy for survival benefit,whereas for patients with no to mild ischemia,medical therapy is the main choice,and revascularization is associated with increased mortality.There is some evidence that revascularization in patients with no or mild ischemia is likely to result in worsened ischemia,which is associated with increased mortality.Studies using fractional flow reserve(FFR) demonstrate that ischemia-guided PCI is superior to angiography-guided PCI,and the presence of ischemia is the key to decisionmaking for PCI.Complementary use of noninvasive MPI and invasive FFR would be important to compensate for each method's limitations.Recent studies of appropriateness criteria showed that,although PCI in the acute setting and coronary bypass surgery are properly performed in most patients,PCI in the non-acute set-ting is often inappropriate,and stress testing to identify myocardial ischemia is performed in less than half of patients.Also,some studies suggested that revascularization in an inappropriate setting is not associated with improved prognosis.Taken together,the presence and the extent of myocardial ischemia is a key factor in the management of patients with stable coronary artery disease,and coronary revascularization in the absence of myocardial ischemia is associated with worsened prognosis.
文摘目的:探讨心血管病危险因素对无或轻度冠状动脉(冠脉)狭窄的非血流受限人群的心肌血流量(MBF)及冠脉血流储备(CFR)的影响。方法:回顾性分析在本科室完成13N-氨水正电子发射计算机断层成像(PET)心肌灌注显像(MPI)、冠脉计算机断层摄影术(CT)血管造影(CTA)或冠脉造影(CAG)检查提示无或轻度冠脉狭窄的68例受检者,收集整理一般资料(包括年龄、性别、体重指数)及冠心病传统危险因素(糖尿病、高血压、血脂异常、长期吸烟、心血管病家族史)、潜在危险因素(包括阻塞性睡眠呼吸暂停综合征、肿瘤术后化疗后、甲状腺功能亢进症),经绝对定量分析获得静息及负荷MBF、左心室整体CFR。用χ~2检验、二元Logistic回归法分析上述危险因素对心肌灌注的影响。结果:单因素分析发现,男性的负荷MBF低于女性[(3.02±0.72)ml/(min·gm) vs(3.77±0.86)ml/(min·gm),χ~2=3.886,P=0.049],年龄>55岁受试者的CFR最小值(CFRmin)较≤55岁者减低(2.12±0.37 vs2.62±0.67,χ~2=10.236,P=0.001),糖尿病患者CFRmin(2.17±0.44 vs 2.51±0.65,χ~2=5.798,P=0.016)、负荷MBF[(2.79±0.64)ml/(min·gm) vs(3.57±0.86)ml/(min·gm),χ~2=7.053,P=0.008]低于无糖尿病者,存在潜在危险因素人群的CFR平均值(CFRmean)低于无潜在危险因素人群(2.42±0.44 vs 3.30±0.72,P=0.003)。多因素Logistic回归分析结果提示,糖尿病(OR=5.471,95%CI:1.040～28.788)、年龄>55岁(OR=6.213,95%CI:1.758～21.955)是CFRmin减低的危险因素;糖尿病是负荷MBF减低的危险因素(OR=9.444,95%CI:1.912～46.646);潜在危险因素是CFRmean减低的危险因素(OR=18.667,95%CI:2.807～124.145)。结论:(1)心血管病危险因素对静息MBF影响很小;(2)年龄、性别对负荷MBF、CFR有影响;(3)传统心血管病危险因素中,糖尿病对负荷MBF、CFR的影响不容忽视;(4)相比传统心血管病危险因素,潜在危险因素对CFR的影响更为显著,需高度重视,及时纠正或预防。
