Vessel fractional flow reserve in assessment of non-culprit lesions in ST elevation myocardial infarction

被引:2
|
作者
Chang, Chun Chin [1 ,2 ,3 ,4 ]
Chuang, Ming Ju [1 ,3 ]
Lee, Yin Hao [1 ,3 ]
Tsai, Yi Lin [1 ,3 ]
Lu, Ya Wen [1 ,3 ]
Chou, Ruey Hsing [1 ,2 ,3 ,5 ]
Wu, Cheng Hsueh [1 ,3 ,5 ]
Lu, Tse Min [1 ,2 ,6 ]
Huang, Po Hsun [1 ,2 ,3 ,5 ]
Lin, Shing Jong [1 ,2 ,3 ,7 ]
机构
[1] Taipei Vet Gen Hosp, Dept Internal Med, Div Cardiol, Taipei, Taiwan
[2] Natl Yang Ming Chiao Tung Univ, Inst Clin Med, Taipei, Taiwan
[3] Natl Yang Ming Chiao Tung Univ, Cardiovasc Res Ctr, Taipei, Taiwan
[4] Erasmus MC, Thoraxctr, Dept Cardiol, Rotterdam, Netherlands
[5] Taipei Vet Gen Hosp, Dept Crit Care Med, Taipei, Taiwan
[6] Taipei Vet Gen Hosp, Healthcare & Serv Ctr, Taipei, Taiwan
[7] Taipei Med Univ, Taipei Heart Inst, Taipei, Taiwan
来源
OPEN HEART | 2021年 / 8卷 / 02期
关键词
acute coronary syndrome; coronary artery disease; coronary stenosis; PERCUTANEOUS CORONARY INTERVENTION; REVASCULARIZATION; INSIGHTS; STRATEGY; TRIALS;
D O I
10.1136/openhrt-2021-001691
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives We sought to evaluate the physiology of non-culprit lesions by using vessel fractional flow reserve (vFFR) among patients with ST elevation myocardial infarction (STEMI) and multivessel disease (MVD). Methods From January 2017 to December 2019, 354 patients with STEMI in the Taipei Veterans General Hospital Acute Myocardial Infarction Registry were screened. Patients who underwent successful primary percutaneous coronary intervention (PCI) for culprit lesions, with at least one non-culprit lesion with stenosis of >= 50%, were eligible. vFFR was computed retrospectively. Results A total of 156 patients with 217 non-culprit lesions were eligible for this study. Aortic root pressure and two good angiograms were available for 139 non-culprit lesions for vFFR analysis. Based on the vFFR analysis, 59 non-culprit lesions (43.2%) had a vFFR value >0.80, and PCI was deferred in 45 lesions (76.3%). Meanwhile, 80 non-culprit lesions (56.8%) had a vFFR value <= 0.80; however, PCI was only performed in 31 lesions (38.7%) (p=0.142). The incidence of vessel-oriented composite endpoint was numerically higher in non-culprit lesions with vFFR <= 0.80 than those with vFFR >0.80 (6.3% vs 1.7%, HR: 3.59, 95% CI: 0.42 to 30.8, p=0.243). Conclusion Functional incomplete revascularisation is common among patients with STEMI and MVD. The adoption of vFFR to assess non-culprit lesions may reclassify the coronary revascularisation strategy that is usually guided by angiography only in this acute setting.
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页数:6
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