血管学定量流量比率指导的冠状动脉干预 (FAVOR III中国):多中心随机对照试验
Bo Xu1, Shengxian Tu2, Lei Song1
1Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, National Clinical Research Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Lancet (London, England)
|November 7, 2021
概括
通过皮肤冠状动脉干预 (PCI) 的定量流量比 (QFR) 指导显著改善了患者的结果. 与FAVOR III中国试验中的标准视觉评估相比,这种基于血管造影的方法减少了主要的心脏不良事件.
科学领域:
- 心脏病学
- 干预心脏病学
- 医学成像
背景情况:
- 冠状动脉疾病 (CAD) 的管理主要依赖于血管造影以指导皮肤冠状动脉干预 (PCI).
- 通过血管学对冠状动脉病变的视觉评估在准确识别流量限制阻塞方面存在局限性.
- 基于压力线的生理测量提供了更高的准确性,但比血管造影更少使用.
研究的目的:
- 评估基于血管造影的新型定量流量比 (QFR) 方法在PCI中进行病变选择的有效性.
- 为了确定QFR引导的PCI是否与标准血管学指导相比改善了CAD患者的临床结果.
- 在大型多中心试验中评估QFR对主要心脏不良事件 (MACE) 的影响
主要方法:
- 中国的FAVOR III试验是一项多中心的,盲目的,随机的,模拟控制的研究,涉及3825名患者.
- 患者被分配到以QFR为导向的PCI策略 (PCI如果QFR≤0. 80) 或以血管造影为导向的策略.
- 主要终点是1年的重大心脏不良事件 (MACE) 发生率,包括全因死亡,心肌梗塞或缺血驱动的重血管化.
主要成果:
- 与血管造影指导组 (8. 8%) 相比,QFR指导组的1年MACE率显著降低.
- 这种MACE的减少主要是由于QFR引导的手臂中心肌梗塞和缺血驱动的再血管化较少.
- 在MACE率上的差异具有统计学意义 (危险比率为0. 65;p=0.0004).
结论:
- 在PCI中以QFR为指导的病变选择策略显著改善了冠状动脉疾病患者1年的临床结果.
- 与传统的血管学视觉评估相比,QFR提供了一种更有效的指导PCI方法.
- 这项研究支持QFR作为干预心脏病实践中的一个有价值的工具.
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