血流储备分数用于指导急性ST段抬高型心肌梗死患者非梗死相关血管血运重建的研究进展Progression of non–infarct-related artery revascularization guided by fractional flow reserve in STsegment elevation myocardial infarction patients
李新健,徐昕晔,王贵松
摘要(Abstract):
急性ST段抬高型心肌梗死患者中约有50%合并多支血管病变。既往多项研究证实,对于非梗死相关血管(non-IRA),无论在冠状动脉造影(CAG)或冠状动脉血流储备分数(FFR)指导下进行血运重建均可降低主要不良心血管事件发生率。但近期有研究发现,应用FFR指导的non-IRA血运重建相较于CAG未能带来更多获益。本文拟对相关研究进展进行综述。
关键词(KeyWords): 血流储备分数;非梗死相关血管;完全血运重建
基金项目(Foundation): 国家自然科学基金项目(81870271)
作者(Author): 李新健,徐昕晔,王贵松
参考文献(References):
- [1] Park DW, Clare RM, Schulte PJ, et al. Extent, location,and clinical significance of non-infarct-related coronary artery disease among patients with ST-elevation myocardial infarction[J]. JAMA,2014,312(19):2019-2027.
- [2] Wald DS, Morris JK, Wald NJ, et al. Randomized trial of preventive angioplasty in myocardial infarction[J]. N Engl J Med,2013,369(12):1115-1123.
- [3] Gershlick AH, Khan JN, Kelly DJ, et al. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease:the CvLPRIT trial[J]. J Am Coll Cardiol,2015,65(10):963-972.
- [4] Engstrom T, Kelbaek H, Helqvist S, et al. Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease(DANAMI-3-PRIMULTI):an openlabel, randomised controlled trial[J]. Lancet,2015,386(9994):665-671.
- [5] Smits PC, Abdel-Wahab M, Neumann FJ, et al. Fractional flow reserve-guided multivessel angioplasty in myocardial infarction[J]. N Engl J Med,2017,376(13):1234-1244.
- [6] Levine GN, Bates ER, Blankenship JC, et al. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction:an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction[J]. J Am Coll Cardiol,2016,67(10):1235-1250.
- [7] Ibanez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J]. Eur Heart J,2018,39(2):119-177.
- [8]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南(2019)[J].中华心血管病杂志,2019,10:766-783.
- [9] Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization:a report of the american college of cardiology/american heart association joint committee on clinical practice guidelines[J]. J Am Coll Cardiol,2022,79(2):e21-e129.
- [10]中国冠状动脉血流储备分数测定技术临床路径专家共识专家组.中国冠状动脉血流储备分数测定技术临床路径专家共识[J].中国介入心脏病学杂志,2019,27(3):121-133.
- [11] van Nunen LX, Zimmermann FM, Tonino PA, et al.Fractional fl ow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease(FAME):5-year follow-up of a randomised controlled trial[J]. Lancet,2015,386(10006):1853-1860.
- [12] Tonino PA, De Bruyne B, Pijls NH, et al. Fractional fl ow reserve versus angiography for guiding percutaneous coronary intervention[J]. N Engl J Med,2009,360(3):213-224.
- [13] Gaba P, Gersh BJ, Ali ZA, et al. Complete versus incomplete coronary revascularization:definitions, assessment and outcomes[J]. Nat Rev Cardiol,2021,18(3):155-168.
- [14] Cuculi F, De Maria GL, Meier P, et al. Impact of microvascular obstruction on the assessment of coronary fl ow reserve, index of microcirculatory resistance, and fractional fl ow reserve after ST-segment elevation myocardial infarction[J]. J Am Coll Cardiol,2014,64(18):1894-1904.
- [15] Niccoli G, Indolfi C, Davies JE. Evaluation of intermediate coronary stenoses in acute coronary syndromes using pressure guidewire[J]. Open Heart,2017,4(2):e431.
- [16] Ntalianis A, Sels JW, Davidavicius G, et al. Fractional flow reserve for the assessment of nonculprit coronary artery stenoses in patients with acute myocardial infarction[J]. JACC Cardiovasc Interv,2010,3(12):1274-1281.
- [17] Musto C, De Felice F, Rigattieri S, et al. Instantaneous wave-free ratio and fractional fl ow reserve for the assessment of nonculprit lesions during the index procedure in patients with STsegment elevation myocardial infarction:the WAVE study[J].Am Heart J,2017,193:63-69.
- [18] van der Hoeven NW, Janssens GN, de Waard GA,e t al. Temporal changes in coronary hyperemic and resting hemodynamic indices in nonculprit vessels of patients with STsegment elevation myocardial infarction[J]. JAMA Cardiol,2019,4(8):736-744.
- [19] Piroth Z, Boxma-De KB, Omerovic E, et al. The natural history of nonculprit lesions in STEMI:an FFR substudy of the compare-acute trial[J]. JACC Cardiovasc Interv,2020,13(8):954-961.
- [20] Wang LJ, Han S, Zhang XH, et al. Fractional flow reserve-guided complete revascularization versus culprit-only revascularization in acute ST-segment elevation myocardial infarction and multi-vessel disease patients:a meta-analysis and systematic review[J]. BMC Cardiovasc Disord,2019,19(1):49.
- [21] Neupane S, Singh H, Edla S, et al. Meta-analysis of fractional flow reserve guided complete revascularization versus infarct related artery only revascularization in patients with ST-elevation myocardial infarction and multivessel coronary artery disease[J]. Coron Artery Dis,2019,30(6):393-397.
- [22] Mehta SR, Wood DA, Storey RF, et al. Complete revascularization with multivessel pci for myocardial infarction[J]. N Engl J Med,2019,381(15):1411-1421.
- [23] Smits PC, Laforgia PL, Abdel-Wahab M, et al. Fractional flow reserve-guided multivessel angioplasty in myocardial infarction:three-year follow-up with cost benefi t analysis of the Compare-Acute trial[J]. EuroIntervention,2020,16(3):225-232.
- [24] Sels JW, Tonino PA, Siebert U, et al. Fractional fl ow reserve in unstable angina and non-ST-segment elevation myocardial infarction experience from the FAME(fractional flow reserve versus angiography for multivessel evaluation)study[J].JACC Cardiovasc Interv,2011,4(11):1183-1189.
- [25] Layland J, Oldroyd KG, Curzen N, et al. Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction:the British Heart Foundation FAMOUS-NSTEMI randomized trial[J]. Eur Heart J,2015,36(2):100-111.
- [26] Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization[J]. Eur Heart J,2019,40(2):87-165.
- [27] Puymirat E, Cayla G, Simon T, et al. Multivessel PCI guided by FFR or angiography for myocardial infarction[J]. N Engl J Med,2021,385(4):297-308.
- [28] Juni P. PCI for nonculprit lesions in patients with STEMI-no role for FFR[J]. N Engl J Med,2021,385(4):370-371.
- [29] Wald DS, Hadyanto S, Bestwick JP. Should fractional flow reserve follow angiographic visual inspection to guide preventive percutaneous coronary intervention in ST-elevation myocardial infarction[J]? Eur Heart J Qual Care Clin Outcomes,2020,6(3):186-192.
- [30] Gallone G, Angelini F, Fortuni F, et al. Angiography-vs.physiology-guided complete revascularization in patients with ST-elevation myocardial infarction and multivessel disease:who is the better gatekeeper in this setting? A meta-analysis of randomized controlled trials[J]. Eur Heart J Qual Care Clin Outcomes,2020,6(3):199-200.
- [31] De Backer O, Lonborg J, Helqvist S, et al. Characterisation of lesions undergoing ischaemia-driven revascularisation after complete revascularisation versus culprit lesion only in patients with STEMI and multivessel disease:a DANAMI-3-PRIMULTI substudy[J]. EuroIntervention,2019,15(2):172-179.
- [32] Denormandie P, Simon T, Cayla G, et al. Compared outcomes of ST-elevation myocardial infarction patients with multivessel disease treated with primary percutaneous coronary intervention and preserved fractional fl ow reserve of non-culprit lesions treated conservatively and of those with low fractional fl ow reserve managed invasively:insights from the FLOWER MI trial[J]. Circ Cardiovasc Interv,2021,14(11):e011314.
- [33] Pinilla-Echeverri N, Mehta SR, Wang J, et al. Nonculprit lesion plaque morphology in patients with ST-segment-elevation myocardial infarction:results from the COMPLETE trial optical coherence tomography substudys[J]. Circ Cardiovasc Interv,2020,13(7):e8768.
- [34] Montone RA, Meucci MC, Niccoli G. The management of non-culprit coronary lesions in patients with acute coronary syndrome[J]. Eur Heart J Suppl,2020,22(Suppl L):L170-L175.
- [35] Ibanez B, Roque D, Price S. The year in cardiovascular medicine 2020:acute coronary syndromes and intensive cardiac care[J]. Eur Heart J,2021,42(9):884-895.