Prognostic Impact Of Functionally Complete Revascularization Guided By FFR In Patients With NSTE-ACS And Multivessel Disease

BackgroundMultivessel disease(MVD)interventional treatment has obvious advantages in alleviating the symptoms of myocardial ischemia and improving the prognosis of patients.However,unnecessary interventional therapy not only increases the patient’s economic burden,but also increases the surgical complications.Therefore,it is necessary to use an effective and convenient detection means to assess the actual ischemic lesions.Fractional flow reserve(FFR)is a physiological index of myocardial ischemia.It can be used to identify the vessels of myocardial ischemia in MVD.Interventional therapy for patients with MVD guided by FRR has been recommended by multiple guidelines.In patients with non-ST segment elevation acute coronary syndrome and multivessel disease,we are unknown whether it is safe or even desirable to choose one-time PCI functionally complete revascularization guided by FFR.ObjectiveThe purpose of this study was to compare one-time PCI functionally complete revascularization guided by FFR and staged PCI complete revascularization guided by coronary angiography(CAG)alone in patients with NSTE-ACS and MVD.MethodThis study included 100 patients with NSTE-ACS and MVD accommodated in Xijing Hospital from January 2015 to December 2015.All of the patients have received CAG and were randomly divided into one-time PCI functionally complete revascularization guided by FFR(one-time PCI group)and staged PCI complete revascularization guided by CAG alone(staged PCI group).Patients assigned to one-time PCI group underwent stenting of indicated lesions only if FFR<0.75 and completly revascularization performed by a single PCI,whereas those assigned to staged PCI group underwent stenting of all indicated lesions with stenosis≥70% and staged PCI achieved anatomic complete revascularization.The clinical data,coronary angiography results and the data of PCI were recorded.The number of stent used per patient,procedure time,hospitalization time,surgical complications and the amount of contrast agent used per patient were compared between the two groups.The numbers of monthly angina attacks,LVEF and major adverse cardiovascular events(MACE)were compared between the two groups in one month and one year after PCI surgery.Results:1.There were no significant difference in age,male proportion,hypertension,hyperlipidemia,diabetes mellitus,previous myocardial infarction,LVEF and GRACE score between the two groups.2.There were 272 lesions with stenosis≥70% and 124 lesions in one-time PCI group;102 lesions were further evaluated by fractional flow reserve and 74(72.5%)lesions FFR<0.75,the mean value of FFR was 0.60±0.13.There were no obvious difference in the mean numbers of indicated lesions [(2.6±1.0)vs(2.7±0.8),P=0.62],mean stenosis degree [(79.3±5.7)% vs(82.3±7.2)%,P=0.25] and lesion location between one-time PCI group and staged PCI group.3.Compared with the staged PCI group,the mean number of stents [(2.4±1.8)vs(3.4±1.5),P<0.01],the total length of stent [(54.6±30.9)vs(68.3±22.8),P=0.04],the hospitalization time [(3.5±2.0)vs(6.5±1.5),P=0.04] was obvious decreased in one-time PCI group;there were no obvious difference in the amount of contrast agent used per patient [(220±70)ml vs(190±60)ml,P=0.08],procedure times [(110±50)min vs(90±45)min,P=0.10] and surgical complications [6(12.0)% vs [4(8.0%),P=0.50] between the two groups.4.There were no obvious difference in the incidence of MACE between one-time PCI group and staged PCI group in one month and one year after PCI surgery,but the numbers of monthly angina attacks [(2.1±0.6)vs(4.1±0.8),P=0.03]and LVEF[(64.7±5.8)vs(55.0±8.9),P=0.04)] in one-time PCI group was significant improved compared that in staged PCI group.Conclusions:1.One-time PCI functionally complete revascularization guided by FFR is safe and feasible,it also can reduce unnecessary stent implantation and hospitalization time in patients with NSTE-ACS and MVD.2.One-time PCI functionally complete revascularization guided by FFR is effective in improving the symptoms of angina attacks and LVEF in one month after surgery.3.There was no obvious difference in the incidence of MACE between one-time PCI group and staged PCI group in one month and one year after surgery,the short-term prognosis of patients was not inferior to that staged PCI complete revascularization guided by coronary angiography alone.