传统PCI
医学
心脏病学
部分流量储备
内科学
经皮冠状动脉介入治疗
血运重建
冠状动脉疾病
心肌梗塞
临床终点
动脉
血管造影
放射科
冠状动脉造影
随机对照试验
作者
Yuhei Kobayashi,Tatsunori Takahashi,Frederik M. Zimmermann,Hisao Otsuki,Mohamed El Farissi,Keith G. Oldroyd,Olaf Wendler,Michael J. Reardon,Y. Joseph Woo,Alan C. Yeung,Bernard De Bruyne,Nico H.J. Pijls,William F. Fearon
标识
DOI:10.1016/j.jcin.2023.06.023
摘要
The functional SYNTAX score (FSS), which incorporates functional information as assessed by fractional flow reserve (FFR), is a better predictor of outcome after percutaneous coronary intervention (PCI) in patients with less complex coronary artery disease (CAD).This study sought to test the prognostic value of the FSS in patients with complex CAD eligible for coronary artery bypass grafting (CABG).The FAME 3 (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 3) trial compared FFR-guided PCI with CABG in patients with angiographic 3-vessel CAD. In this prespecified substudy, the angiographic core laboratory calculated the SYNTAX score (SS) and then the FSS by eliminating lesions that were not significant based on FFR. Outcomes in the PCI patients based on the FSS and the SS were compared to each other and to the patients treated with CABG.The FSS reclassified more than one-quarter of patients from an SS >22 to an FSS ≤22. In the 50% of PCI patients who had an FSS ≤22, the primary endpoint occurred at a similar rate to patients treated with CABG (P = 0.77). The primary endpoint in patients without functionally significant 3-vessel CAD was similar to the CABG group (P = 0.97). The rate of myocardial infarction and revascularization among all deferred lesions was 0.5% and 3.2%, respectively.By measuring the FSS, one can identify 50% of patients who have a similar outcome at 1 year with PCI compared with CABG. Lesions deferred from PCI based on FFR have a low event rate.
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