{"id":22577,"date":"2022-10-03T04:28:00","date_gmt":"2022-10-02T20:28:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=22577"},"modified":"2022-10-03T07:56:00","modified_gmt":"2022-10-02T23:56:00","slug":"nejm%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e8%a1%80%e6%b5%81%e5%82%a8%e5%a4%87%e5%88%86%e6%95%b0%e5%92%8c%e8%a1%80%e7%ae%a1%e5%86%85%e8%b6%85%e5%a3%b0%e6%88%90%e5%83%8f%e6%8c%87%e5%af%bcpci","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=22577","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]\uff1a\u8840\u6d41\u50a8\u5907\u5206\u6570\u548c\u8840\u7ba1\u5185\u8d85\u58f0\u6210\u50cf\u6307\u5bfcPCI"},"content":{"rendered":"\n

ORIGINAL ARTICLE<\/a><\/p>\n\n\n\n

Fractional Flow Reserve or Intravascular Ultrasonography to Guide PCI<\/h1>\n\n\n\n

Bon-Kwon Koo, Xinyang Hu, Jeehoon Kang,\u00a0et al<\/h3>\n\n\n\n

N Engl J Med 2022; 387:779-789
DOI: 10.1056\/NEJMoa2201546<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

BACKGROUND<\/h2>\n\n\n\n

In patients with coronary artery disease who are being evaluated for percutaneous coronary intervention (PCI), procedures can be guided by fractional flow reserve (FFR) or intravascular ultrasonography (IVUS) for decision making regarding revascularization and stent implantation. However, the differences in clinical outcomes when only one method is used for both purposes are unclear.<\/p>\n\n\n\n

\u5728\u63a5\u53d7\u7ecf\u76ae\u51a0\u72b6\u52a8\u8109\u4ecb\u5165\u6cbb\u7597\uff08PCI\uff09\u8bc4\u4f30\u7684\u51a0\u5fc3\u75c5\u60a3\u8005\u4e2d\uff0c\u53ef\u4ee5\u901a\u8fc7\u8840\u6d41\u50a8\u5907\u5206\u6570\uff08FFR\uff09\u6216\u8840\u7ba1\u5185\u8d85\u58f0\u6210\u50cf\uff08IVUS\uff09\u6765\u6307\u5bfc\u6709\u5173\u8840\u8fd0\u91cd\u5efa\u548c\u652f\u67b6\u690d\u5165\u7684\u51b3\u7b56\u3002\u7136\u800c\uff0c\u5f53\u4e00\u79cd\u65b9\u6cd5\u540c\u65f6\u7528\u4e8e\u4e24\u79cd\u76ee\u7684\u65f6\uff0c\u4e34\u5e8a\u7ed3\u5c40\u7684\u5dee\u5f02\u5c1a\u4e0d\u660e\u786e\u3002<\/p>\n\n\n\n

METHODS<\/h2>\n\n\n\n

We randomly assigned 1682 patients who were being evaluated for PCI for the treatment of intermediate stenosis (40 to 70% occlusion by visual estimation on coronary angiography) in a 1:1 ratio to undergo either an FFR-guided or IVUS-guided procedure. FFR or IVUS was to be used to determine whether to perform PCI and to assess PCI success. In the FFR group, PCI was to be performed if the FFR was 0.80 or less. In the IVUS group, the criteria for PCI were a minimal lumen area measuring either 3 mm2<\/sup>\u00a0or less or measuring 3 to 4 mm2<\/sup>\u00a0with a plaque burden of more than 70%. The primary outcome was a composite of death, myocardial infarction, or revascularization at 24 months after randomization. We tested the noninferiority of the FFR group as compared with the IVUS group (noninferiority margin, 2.5 percentage points).<\/p>\n\n\n\n

\u6211\u4eec\u4ee51\u22361\u7684\u6bd4\u4f8b\u5c06\u56e0\u4e2d\u5ea6\u72ed\u7a84\uff08\u51a0\u72b6\u52a8\u8109\u9020\u5f71\u76ee\u6d4b40%\uff5e70%\u5835\u585e\uff09\u63a5\u53d7PCI\u6cbb\u7597\u8bc4\u4f30\u76841,682\u4f8b\u60a3\u8005\u968f\u673a\u5206\u7ec4\uff0c\u5206\u522b\u63a5\u53d7FFR\u6307\u5bfcPCI\u6216IVUS\u6307\u5bfcPCI\u3002FFR\u6216IVUS\u7528\u4e8e\u786e\u5b9a\u662f\u5426\u8fdb\u884cPCI\u5e76\u8bc4\u4f30PCI\u6210\u529f\u4e0e\u5426\u3002\u5728FFR\u7ec4\u4e2d\uff0c\u5982\u679cFFR\u22640.80\uff0c\u5219\u8fdb\u884cPCI\u3002\u5728IVUS\u7ec4\u4e2d\uff0cPCI\u6807\u51c6\u662f\u6700\u5c0f\u7ba1\u8154\u9762\u79ef\u22643 mm2<\/sup>\u6216\u6700\u5c0f\u7ba1\u8154\u9762\u79ef\u4e3a3\uff5e4 mm2<\/sup>\u5e76\u4e14\u6591\u5757\u8d1f\u8377\uff1e70%\u3002\u4e3b\u8981\u7ed3\u5c40\u662f\u968f\u673a\u5206\u7ec4\u540e24\u4e2a\u6708\u65f6\u7531\u6b7b\u4ea1\u3001\u5fc3\u808c\u6897\u6b7b\u6216\u8840\u8fd0\u91cd\u5efa\u6784\u6210\u7684\u590d\u5408\u7ed3\u5c40\u3002\u6211\u4eec\u68c0\u9a8c\u4e86FFR\u7ec4\u4e0eIVUS\u7ec4\u76f8\u6bd4\u7684\u975e\u52a3\u6548\u6027\uff08\u975e\u52a3\u6548\u6027\u754c\u503c\uff0c2.5\u4e2a\u767e\u5206\u70b9\uff09\u3002<\/a><\/p>\n\n\n\n

RESULTS<\/h2>\n\n\n\n

The frequency of PCI was 44.4% among patients in the FFR group and 65.3% among those in the IVUS group. At 24 months, a primary-outcome event had occurred in 8.1% of the patients in the FFR group and in 8.5% of those in the IVUS group (absolute difference, \u22120.4 percentage points; upper boundary of the one-sided 97.5% confidence interval, 2.2 percentage points; P=0.01 for noninferiority). Patient-reported outcomes as reported on the Seattle Angina Questionnaire were similar in the two groups.<\/p>\n\n\n\n

\u5728FFR\u7ec4\u548cIVUS\u7ec4\u4e2d\uff0c\u63a5\u53d7PCI\u7684\u60a3\u8005\u6bd4\u4f8b\u5206\u522b\u4e3a44.4%\u548c65.3%\u300224\u4e2a\u6708\u65f6\uff0cFFR\u7ec48.1%\u7684\u60a3\u8005\u548cIVUS\u7ec48.5%\u7684\u60a3\u8005\u53d1\u751f\u4e86\u4e3b\u8981\u7ed3\u5c40\u4e8b\u4ef6\uff08\u7edd\u5bf9\u5dee\uff0c\uff0d0.4\u4e2a\u767e\u5206\u70b9\uff1b\u5355\u4fa797.5%\u7f6e\u4fe1\u533a\u95f4\u4e0a\u9650\uff0c2.2\u4e2a\u767e\u5206\u70b9\uff1b\u975e\u52a3\u6548\u6027\u7684P<\/em>=0.01\uff09\u3002\u4e24\u7ec4\u897f\u96c5\u56fe\u5fc3\u7ede\u75db\u95ee\u5377\u4e0a\u60a3\u8005\u62a5\u544a\u7684\u7ed3\u5c40\u76f8\u4f3c\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

CONCLUSIONS<\/h2>\n\n\n\n

In patients with intermediate stenosis who were being evaluated for PCI, FFR guidance was noninferior to IVUS guidance with respect to the composite primary outcome of death, myocardial infarction, or revascularization at 24 months. (Funded by Boston Scientific; FLAVOUR ClinicalTrials.gov number,\u00a0NCT02673424. opens in new tab<\/a>.)<\/p>\n\n\n\n

\u5728\u63a5\u53d7PCI\u8bc4\u4f30\u7684\u51a0\u72b6\u52a8\u8109\u4e2d\u5ea6\u72ed\u7a84\u60a3\u8005\u4e2d\uff0c\u572824\u4e2a\u6708\u65f6\u7684\u6b7b\u4ea1\u3001\u5fc3\u808c\u6897\u6b7b\u6216\u8840\u8fd0\u91cd\u5efa\u6784\u6210\u7684\u590d\u5408\u4e3b\u8981\u7ed3\u5c40\u65b9\u9762\uff0cFFR\u6307\u5bfcPCI\u4e0d\u52a3\u4e8eIVUS\u6307\u5bfcPCI\uff08\u7531\u6ce2\u58eb\u987f\u79d1\u5b66\u516c\u53f8[Boston Scientific]\u8d44\u52a9\uff1bFLAVOUR\u5728ClinicalTrials.gov\u6ce8\u518c\u53f7\u4e3aNCT02673424\uff09\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"

ORIGINAL ARTICLE Fractional Flow Reserve or Intravascul […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22577"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=22577"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22577\/revisions"}],"predecessor-version":[{"id":22578,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22577\/revisions\/22578"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=22577"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=22577"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=22577"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}