Fractional flow reserve vs angiography to guide percutaneous coronary intervention: an individual patient data meta-analysis.

This individual patient data meta-analysisfocused on trials where FFR was used to assess intermediate coronary lesions in chronic coronary syndrome (CCS) or non-culprit vessels in non-ST-elevation acute coronary syndromes (NSTE-ACS).

这项针对个体患者数据的荟萃分析关注的是在慢性冠状动脉综合征（CCS）中使用分数血流储备（FFR）评估中度冠状动脉病变或在非ST段抬高型急性冠状动脉综合征（NSTE-ACS）中评估非罪犯血管的试验。

Methods

Randomized controlled trials comparing FFR- vs angiography-guided PCI with a minimum follow-up of 1 year were searched.

比较基于血流储备分数(FFR)与基于冠状动脉造影指导的经皮冠状动脉介入治疗(PCI)的随机对照试验，随访时间至少为1年。

Studies lacking angiographic inclusion criteria or using FFR for culprit arteries in NSTE-ACS were excluded.

排除了缺乏冠状动脉造影纳入标准的试验，或在非ST段抬高型急性冠脉综合征(NSTE-ACS)中仅对罪犯血管使用FFR的试验。

Studies including patients with ST-elevation myocardial infarction (MI) or undergoing surgical revascularization could be included after censoring these two subgroups.

研究可以包括ST段抬高型心肌梗死（MI）患者或接受手术血运重建的患者，但在排除这两个亚组后才能纳入。

The primary outcome was the 1-year rate of major adverse cardiac events (MACE), defined as a composite of all-cause death, MI, and repeat revascularization.

主要结果是1年内主要不良心脏事件（MACE）的发生率，定义为全因死亡、心肌梗死和再次血运重建的复合结果。

The secondary outcomes were a composite of all-cause death and MI, the individual components of the primary outcome, cardiac death, spontaneous MI, and procedural MI.

次要结果是所有原因死亡和心肌梗死的复合终点，主要结果的各个组成部分，心脏死亡，自发性心肌梗死和程序性心肌梗死。

The present study is registered with PROSPERO (CRD42024553676).

本研究已在PROSPERO注册（CRD42024553676）。

Results

Five RCTs were selected, including 2493 patients: 1241 in the angiography arm and 1252 in the FFR arm.

选出了五项随机对照试验，共纳入2493名患者：其中1241名患者在血管造影组，1252名患者在FFR组。

More vessels underwent PCI in the angiography group (45.1% vs 30.2%, P < .001), with more stents implanted per patient [2.0 (2.0-3.0) vs 1.5 (1.0-2.0), P < .001].

血管造影组中接受经皮冠状动脉介入治疗(PCI)的血管更多(45.1% vs 30.2%，P < .001)，每位患者植入的支架数量也更多[2.0 (2.0-3.0) vs 1.5 (1.0-2.0)，P < .001]。

One-year MACE occurred in 14.7% of patients in the angiography group and 12.1% in the FFR group [hazard ratio(HR) .80, 95% confidence interval(CI) .64-.99; P = .046].

一年内主要不良心血管事件（MACE）的发生率在血管造影组为14.7%，在血流储备分数（FFR）组为12.1% [风险比（HR）0.80，95%置信区间（CI）0.64-0.99；P = .046]。

The risk of MI was significantly reduced in the FFR-guided group (HR .71, 95% CI .53-.96; P = .031).

在FFR指导组中，心肌梗死（MI）的风险显著降低（HR 0.71，95% CI 0.53-0.96；P = .031）。

These outcomes were driven by a reduction in peri-procedural MI with FFR guidance, with no significant difference between groups in non-procedural MI, MACE between 30 days and 1 year, and secondary outcomes.

这些结果主要由FFR指导下的围手术期心肌梗死（MI）减少所驱动，两组在非手术期心肌梗死、30天至1年间的MACE（主要不良心血管事件）以及次要结果之间没有显著差异。

Conclusions

Fractional flow reserve-guided PCI was associated with reduced major adverse events in patients with CCS and NSTE-ACS due mainly to fewer peri-procedural MIs, with no differences in mortality or MACE beyond 30 days.

在有稳定型心绞痛（CCS）和非ST段抬高型急性冠脉综合征（NSTE-ACS）的患者中，FFR指导下的经皮冠状动脉介入治疗（PCI）与主要不良事件的减少相关，这主要是由于围手术期心肌梗死（MI）的减少，而在30天后死亡率或MACE（主要不良心血管事件）方面没有差异。