Fractional Flow Reserve-Guided Strategy in Acute Coronary Syndrome. A Systematic Review and Meta-Analysis

Abstract Background: There are limited data on the prognosis of deferral of lesion treatment in patients with acute coronary syndrome (ACS) based on fractional flow reserve (FFR). Objectives: To provide a systematic review of the current evidence on the prognosis of deferred lesions in ACS patients compared with deferred lesions in non-ACS patients, on the basis of FFR. Methods: We searched Medline, EMBASE, and the Cochrane Library for studies published between January 2000 and September 2017 that compared prognosis of deferred revascularization of lesions on the basis of FFR in ACS patients compared with non-ACS patients. We conducted a pooled relative risk meta-analysis of four primary outcomes: mortality, cardiovascular (CV) mortality, myocardial infarction (MI) and target-vessel revascularization (TVR). Results: We identified 7 studies that included a total of 5,107 patients. A pooled meta-analysis showed no significant difference in mortality (relative risk [RR] = 1.44; 95% CI, 0.9-2.4), CV mortality (RR = 1.29; 95% CI = 0.4-4.3) and TVR (RR = 1.46; 95% CI = 0.9-2.3) after deferral of revascularization based on FFR between ACS and non-ACS patients. Such deferral was associated with significant additional risk of MI (RR = 1.83; 95% CI = 1.4-2.4) in ACS patients. Conclusion: The prognostic value of FFR in ACS setting is not as good as in stable patients. The results demonstrate an increased risk of MI but not of mortality, CV mortality, and TVR in ACS patients.

摘要 背景：目前关于基于血流储备分数（fractional flow reserve, FFR）对急性冠脉综合征（acute coronary syndrome, ACS）患者的病变暂缓治疗的预后相关数据较为有限。
研究目的：旨在系统回顾基于血流储备分数，对比急性冠脉综合征患者与非急性冠脉综合征患者的暂缓处理病变的预后相关现有证据。
方法：我们检索了Medline、EMBASE及Cochrane图书馆中2000年1月至2017年9月发表的研究，这些研究对比了基于血流储备分数，急性冠脉综合征患者与非急性冠脉综合征患者的病变暂缓血运重建后的预后情况。我们针对四项主要结局指标开展了合并相对风险（relative risk, RR）的荟萃分析：全因死亡率、心血管（cardiovascular, CV）死亡率、心肌梗死（myocardial infarction, MI）以及靶血管血运重建（target-vessel revascularization, TVR）。
结果：我们共纳入7项研究，涉及5107名患者。合并荟萃分析结果显示，基于血流储备分数暂缓血运重建后，急性冠脉综合征患者与非急性冠脉综合征患者在全因死亡率（相对风险[RR]=1.44；95%置信区间[CI]：0.9~2.4）、心血管死亡率（相对风险[RR]=1.29；95%置信区间[CI]：0.4~4.3）以及靶血管血运重建率（相对风险[RR]=1.46；95%置信区间[CI]：0.9~2.3）方面均无显著差异。但在急性冠脉综合征患者中，此类暂缓血运重建策略与心肌梗死风险的显著升高相关（相对风险[RR]=1.83；95%置信区间[CI]：1.4~2.4）。
结论：血流储备分数在急性冠脉综合征场景下的预后评估价值不如在稳定性冠心病患者中。本研究结果显示，急性冠脉综合征患者在暂缓血运重建后，心肌梗死风险升高，但全因死亡率、心血管死亡率及靶血管血运重建率并无显著升高。