- 作者：Nico H.J. Pijls ; William F. Fearon ; Pim A.L. Tonino ; Uwe Siebert ; Fumiaki Ikeno ; Bernhard Bornschein ; Marcel van't Veer ; Volker Klauss ; Ganesh Manoharan ; Thomas Engstrø ; m ; Keith G. Oldroyd ; Peter
- 关键词：fractional flow reserve ; multivessel coronary artery disease ; drug-eluting stents ; percutaneous coronary intervention ; coronary pressure ; pressure wire
- 刊名：Journal of the American College of Cardiology
- 出版年：2010
- 出版时间：13 July 2010
- 年：2010
- 卷：56
- 期：3
- 页码：177-184
- 全文大小：451 K
Objectives
The purpose of this study was to investigate the 2-year outcome of percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) in patients with multivessel coronary artery disease (CAD).Background
In patients with multivessel CAD undergoing PCI, coronary angiography is the standard method for guiding stent placement. The FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study showed that routine FFR in addition to angiography improves outcomes of PCI at 1 year. It is unknown if these favorable results are maintained at 2 years of follow-up.
Methods
At 20 U.S. and European medical centers, 1,005 patients with multivessel CAD were randomly assigned to PCI with drug-eluting stents guided by angiography alone or guided by FFR measurements. Before randomization, lesions requiring PCI were identified based on their angiographic appearance. Patients randomized to angiography-guided PCI underwent stenting of all indicated lesions, whereas those randomized to FFR-guided PCI underwent stenting of indicated lesions only if the FFR was ≤0.80.
Results
The number of indicated lesions was 2.7 ± 0.9 in the angiography-guided group and 2.8 ± 1.0 in the FFR-guided group (p = 0.34). The number of stents used was 2.7 ± 1.2 and 1.9 ± 1.3, respectively (p < 0.001). The 2-year rates of mortality or myocardial infarction were 12.9 % in the angiography-guided group and 8.4 % in the FFR-guided group (p = 0.02). Rates of PCI or coronary artery bypass surgery were 12.7 % and 10.6 % , respectively (p = 0.30). Combined rates of death, nonfatal myocardial infarction, and revascularization were 22.4 % and 17.9 % , respectively (p = 0.08). For lesions deferred on the basis of FFR >0.80, the rate of myocardial infarction was 0.2 % and the rate of revascularization was 3.2 % after 2 years.
Conclusions
Routine measurement of FFR in patients with multivessel CAD undergoing PCI with drug-eluting stents significantly reduces mortality and myocardial infarction at 2 years when compared with standard angiography-guided PCI. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [FAME]; NCT00267774)