Impact of Bifurcation Lesions on Outcomes After FFR-Guided PCI or CABG.

IF 6.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Interventions Pub Date : 2025-01-01 Epub Date: 2024-12-27 DOI:10.1161/CIRCINTERVENTIONS.124.014610

Daimy M M Dillen, Hisao Otsuki, Kuniaki Takahashi, Yuhei Kobayashi, Zsolt Piroth, Nicolas Noiseux, Badih El Nakadi, Gintaras Kalinauskas, Laszlo Szekely, Giedrius Davidavičius, Koen Teeuwen, Pim A L Tonino, Nico H J Pijls, Bernard De Bruyne, William F Fearon, Frederik M Zimmermann

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引用次数: 0

Abstract

Background: In the era of first-generation drug-eluting stents and angiography-guided percutaneous coronary intervention (PCI), the presence of a bifurcation lesion was associated with adverse outcomes after PCI. In contrast, the presence of a bifurcation lesion had no impact on outcomes following coronary artery bypass grafting (CABG). Therefore, the presence of a coronary bifurcation lesion requires special attention when choosing between CABG and PCI. The aim of this study is to assess whether the presence of a bifurcation lesion still influences clinical outcomes after contemporary PCI using second-generation drug-eluting stent and fractional flow reserve (FFR) guidance versus CABG.

Methods: The randomized FAME 3 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) compared FFR-guided PCI using current drug-eluting stents with CABG in patients with 3-vessel coronary artery disease. The prespecified key end point at 3-year follow-up was the composite of death, myocardial infarction, or stroke. In this substudy, the impact of bifurcation lesions on outcomes after FFR-guided PCI and CABG was investigated.

Results: The FAME 3 trial enrolled 1500 patients and 653 (45.2%) patients had at least 1 true bifurcation lesion. There was no difference in the composite of death, myocardial infarction, or stroke at the 3-year follow-up between patients with or without at least 1 true bifurcation lesion (11.6% versus 10.0%; hazard ratio, 1.17 [95% CI, 0.86-1.61]; P=0.32), regardless of revascularization strategy. The composite end point was not statistically different between FFR-guided PCI and CABG in patients with at least 1 true bifurcation lesion (hazard ratio, 1.27 [95% CI, 0.80-2.00]) or without a true bifurcation lesion (hazard ratio, 1.36 [95% CI, 0.87-2.12]), with no significant interaction (P_interaction=0.81).

Conclusions: In patients with 3-vessel coronary artery disease, the presence of a true bifurcation lesion was not associated with a different treatment effect after FFR-guided PCI with contemporary drug-eluting stent versus CABG.

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分叉病变对ffr引导下PCI或CABG预后的影响。

背景：在第一代药物洗脱支架和血管造影引导下的经皮冠状动脉介入治疗（PCI）时代，分叉病变的存在与PCI术后不良结局相关。相比之下，分叉病变的存在对冠状动脉旁路移植术（CABG）后的结果没有影响。因此，冠状动脉分叉病变的存在需要特别注意在CABG和PCI之间的选择。本研究的目的是评估采用第二代药物洗脱支架和分数血流储备（FFR）指导的当代PCI与CABG后，分支病变的存在是否仍然影响临床结果。方法：随机FAME 3试验（分流血流储备与多支血管造影评估）比较ffr引导下使用当前药物洗脱支架的PCI与三支冠状动脉疾病患者的CABG。预先指定的3年随访的关键终点是死亡、心肌梗死或中风的复合。在本亚研究中，研究了分叉病变对ffr引导下PCI和CABG后预后的影响。结果：FAME 3试验纳入了1500例患者，653例（45.2%）患者至少有1个真分叉病变。在3年随访中，存在或不存在至少1个真分叉病变的患者在死亡、心肌梗死或卒中的综合发生率方面没有差异(11.6% vs 10.0%；风险比，1.17 [95% CI, 0.86-1.61]；P=0.32)，与血运重建策略无关。在至少有一个真分叉病变（风险比，1.27 [95% CI, 0.80-2.00]）或没有真分叉病变（风险比，1.36 [95% CI, 0.87-2.12]）的患者中，ffr引导的PCI和CABG的复合终点无统计学差异，无显著相互作用（p - interaction=0.81）。结论：在患有三支血管冠状动脉疾病的患者中，ffr引导下采用现代药物洗脱支架的PCI与CABG治疗效果的差异与真正分叉病变的存在无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

1.80%

发文量

221

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.