CBS 2019
CBSMD教育中心
中 文

血流储备分数

Abstract

Recommended Article

Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI Individual Lesion-Level Meta-Analysis Comparing Various Doses of Intracoronary Bolus Injection of Adenosine With Intravenous Administration of Adenosine for Fractional Flow Reserve Assessment Impact of Percutaneous Revascularization on Exercise Hemodynamics in Patients With Stable Coronary Disease Prognostic Implication of Thermodilution Coronary Flow Reserve in Patients Undergoing Fractional Flow Reserve Measurement Fractional Flow Reserve-Guided Multivessel Angioplasty in Myocardial Infarction Meta-Analysis of Death and Myocardial Infarction in the DEFINE-FLAIR and iFR-SWEDEHEART Trials Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease

Original Research2017 Apr;10(4). pii: e004460.

JOURNAL:Circ Cardiovasc Interv. Article Link

Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease: A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment

Lønborg J, Engstrøm T, DANAMI 3-PRIMULTI Investigators et al. Keywords: ST-segment–elevation myocardial infarction; coronary angiography; fractional flow reserve; multivessel disease; multivessel percutaneous coronary intervention; percutaneous coronary intervention

ABSTRACT


BACKGROUND The impact of disease severity on the outcome after complete revascularization in patients with ST-segment-elevation myocardial infarction and multivessel disease is uncertain. The objective of this post hoc study was to evaluate the impact of number of diseased vessel, lesion location, and severity of the noninfarct-related stenosis on the effect of fractional flow reserve-guided complete revascularization.


METHODS AND RESULTS - In the DANAMI-3-PRIMULTI study (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), we randomized 627 ST-segment-elevation myocardial infarction patients to fractional flow reserve-guided complete revascularization or infarct-related percutaneous coronary intervention only. In patients with 3-vessel disease, fractional flow reserve-guided complete revascularization reduced the primary end point (all-cause mortality, reinfarction, and ischemia-driven revascularization; hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.17-0.64; P=0.001), with no significant effect in patients with 2-vessel disease (HR, 0.77; 95% CI, 0.47-1.26; P=0.29; P for interaction =0.046). A similar effect was observed in patients with diameter stenosis ≥90% of noninfarct-related arteries (HR, 0.32; 95% CI, 0.18-0.62; P=0.001), but not in patients with less severe lesions (HR, 0.72; 95% CI, 0.44-1.19; P=0.21; P for interaction =0.06). The effect was most pronounced in patients with 3-vessel disease and noninfarct-related stenoses ≥90%, and in this subgroup, there was a nonsignificant reduction in the end point of mortality and reinfarction (HR, 0.32; 95% CI, 0.08-1.32; P=0.09). Proximal versus distal location did not influence the benefit from complete revascularization.

CONCLUSIONS - The benefit from fractional flow reserve-guided complete revascularization in ST-segment-elevation myocardial infarction patients with multivessel disease was dependent on the presence of 3-vessel disease and noninfarct diameter stenosis ≥90% and was particularly pronounced in patients with both of these angiographic characteristics.

CLINICAL TRIAL REGISTRATION - URL: http://www.clinicaltrials.gov. Unique identifier: NCT01960933.

© 2017 American Heart Association, Inc.