在糖尿病患者中,FFR引导的皮肤冠状动脉干预与冠状动脉旁路移植
Kuniaki Takahashi1,2, Hisao Otsuki1,2, Frederik M Zimmermann3,4
1Stanford University School of Medicine, Stanford University, Stanford, California.
JAMA cardiology
|March 12, 2025
概括
冠状动脉旁路移植 (CABG) 对患有和没有糖尿病的患者,与部分流量储备 (FFR) 引导的皮肤冠状动脉干预 (PCI) 相比,显示出类似的益处. 这一发现适用于不同的SYNTAX得分,影响主要的不良心脏事件.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 糖尿病管理 糖尿病管理
背景情况:
- 在糖尿病患者中,FFR引导PCI与CABG的结果尚未得到充分确立.
- 当前一代的药物排泄支架 (DES) 在PCI中被广泛使用.
- 了解糖尿病患者治疗效果对于心血管保健至关重要.
研究的目的:
- 为了比较PCI与CABG在糖尿病患者中的有效性.
- 分析重心和脑血管重大不良事件 (MACCE) 在重血管化后3年.
- 评估SYNTAX评分对治疗结果的影响.
主要方法:
- 对FAME 3随机临床试验的子组分析.
- 包括患有三血管冠状动脉疾病的患者,没有左主干涉.
- 将FFR引导PCI与当前一代DES与CABG进行比较.
主要成果:
- 与非糖尿病患者相比,糖尿病患者在3年内患MACCE的风险更高.
- 与CABG相比,PCI后MACCE的风险在糖尿病患者和非糖尿病患者中都更高.
- 对于较低的SYNTAX分数,PCI和CABG之间的MACCE没有显著差异;PCI显示中高SYNTAX分数的MACCE风险较高.
结论:
- 与FFR指导的PCI相比,CABG对糖尿病患者和没有糖尿病患者的相对益处类似.
- SYNTAX评分会影响重血管化策略的选择,特别是在糖尿病患者中.
- 在SYNTAX得分中等至高的患者中,无论糖尿病状况如何,CABG可能比PCI更好.
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