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：目前基于血流储备分数（fractional flow reserve, FFR）的急性冠脉综合征（acute coronary syndrome, ACS）患者病变暂缓治疗的预后相关数据较为有限。目的：系统评价现有证据，对比基于血流储备分数（FFR）的急性冠脉综合征患者与非急性冠脉综合征患者的暂缓病变治疗后预后情况。方法：我们检索了MEDLINE、EMBASE与考克兰图书馆（Cochrane Library）中2000年1月至2017年9月发表的相关研究，这些研究对比了基于血流储备分数（FFR）的急性冠脉综合征患者与非急性冠脉综合征患者的靶病变暂缓血运重建后的预后情况。我们对四项主要结局指标开展了合并相对风险的荟萃分析：死亡率、心血管（cardiovascular, CV）死亡率、心肌梗死（myocardial infarction, MI）及靶血管血运重建（target-vessel revascularization, TVR）。结果：本研究共纳入7项研究，总计纳入5107名患者。合并荟萃分析结果显示，急性冠脉综合征患者与非急性冠脉综合征患者在基于血流储备分数（FFR）暂缓血运重建后的死亡率（相对风险[RR]=1.44；95%置信区间[CI], 0.9~2.4）、心血管死亡率（RR=1.29；95% CI=0.4~4.3）与靶血管血运重建率（RR=1.46；95% CI=0.9~2.3）均无显著统计学差异。此类暂缓治疗策略与急性冠脉综合征患者的心肌梗死风险显著升高相关（RR=1.83；95% CI=1.4~2.4）。结论：血流储备分数（FFR）在急性冠脉综合征场景中的预后价值不及稳定型患者。本研究结果表明，急性冠脉综合征患者的心肌梗死风险升高，但死亡率、心血管死亡率与靶血管血运重建风险并无显著升高。