在患有心肌梗塞的患者中,以FFR为指导的完整PCI或仅为罪祸首的PCI
Felix Böhm1, Brynjölfur Mogensen1, Thomas Engstrøm1
1From the Department of Cardiology, Karolinska Institute and Danderyd Hospital, Danderyd (F.B., B.M., R.L.), the Department of Cardiology, Karolinska Institute and Karolinska University Hospital, Stockholm (A.R.), the Department of Cardiology, Linköping University Hospital, Linköping (S.Z.), the Department of Cardiology, Mälarsjukhuset, Eskilstuna (M.H.), the Department of Cardiology, Central Hospital, Karlstad (T.K.), the Department of Cardiology, Ryhov Hospital, Jönköping (J. Lauermann), the Department of Cardiology, Umeå University Hospital, Umeå (J.A.), the Department of Cardiology, Sahlgrenska University Hospital, and the Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg (O.A.), and the Department of Medical Sciences, Cardiology (H.R., C.H., O.Ö., S.J.), and Uppsala Clinical Research Center (C.H., S.J.), Uppsala University, Uppsala - all in Sweden; the Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen (T.E., J. Lønborg); the University Clinical Center of Serbia and the Faculty of Medicine, University of Belgrade, Belgrade (G.S.), and the Faculty of Medicine, University of Novi Sad, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica (I.S.) - all in Serbia; the Heart Hospital, Tampere University Hospital, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (O.A.K.), and the Heart and Lung Center, Helsinki University Central Hospital, Helsinki (M.L.) - all in Finland; the Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A..); the Cardiology Department, Waikato Hospital, Hamilton, New Zealand (M.M.); and the Medical School, University of Western Australia, and the Department of Cardiology, Royal Perth Hospital - both in Perth, WA (C.S.).
分量流量储备 (FFR) 引导的完整重血管化与罪祸首损伤单独的PCI相比,在ST段升高心肌梗塞 (STEMI) 多血管疾病患者中没有显著减少不良事件. 这一发现表明,在这个高危人群中,综合治疗没有额外的益处.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 临床试验 临床试验
背景情况:
- 在ST段升高心肌梗塞 (STEMI) 患有多血管冠状动脉疾病的患者中,以分数流量储备 (FFR) 为指导的完全重血管化的临床益处尚未得到充分证实.
- 在STEMI患者的多血管冠状动脉疾病中,呈现出复杂的治疗场景,需要仔细考虑重血管化策略.
研究的目的:
- 评估FFR引导的完整重血管化的疗效与STEMI和多血管冠状动脉疾病患者的罪祸首损伤单纯的皮肤冠状动脉干预 (PCI) 的疗效.
- 为了确定完全重血管化的策略是否能改善这种特定患者群体的临床结果.
主要方法:
- 一项基于注册的多国随机试验,涉及1542名患有STEMI或非常高风险非STEMI (NSTEMI) 和多血管疾病的患者.
- 接受罪祸首病变初级PCI的患者被随机分配到非罪祸首病变的FFR导向完整再血管化或仅为罪祸首病变的PCI.
- 主要结局是由任何原因导致的死亡,心肌梗塞或无计划的再血管化,随访时间中位数为4.8年.
主要成果:
- 在FFR引导的完整复血管化组 (19.0%) 和罪祸首-损伤单独的PCI组 (20.4%) (危险比,0.93;95% CI,0.74至1.17;P=0.53) 之间没有观察到主要结果的显著差异.
- 二次结局,包括死亡或心肌梗塞和计划外的再血管化,也显示没有显著的群体之间的差异.
- 两种治疗策略之间的安全结果是可比的.
结论:
- 在患有STEMI和多血管冠状动脉疾病的患者中,FFR引导的完整重血管化并没有显著减少死亡,心肌梗塞或意外重血管化的复合结果,而不是与罪祸首损伤单独的PCI相比.
- 结果表明,对于这个患者队列,在近5年的随访期内,添加FFR导向的完整再血管化对标准的罪祸首-损伤-仅PCI没有显著的临床优势.


