{"title":"Pd/Pa 的变化：Pd/Pa 变化：预测冠状动脉延迟病变未来心脏事件的临床意义。","authors":"Kota Murai, Yu Kataoka, Eri Kiyoshige, Takamasa Iwai, Kenichiro Sawada, Hideo Matama, Hiroyuki Miura, Satoshi Honda, Masashi Fujino, Shuichi Yoneda, Kazuhiro Nakao, Kensuke Takagi, Fumiyuki Otsuka, Yasuhide Asaumi, Kunihiro Nishimura, Teruo Noguchi","doi":"10.1161/CIRCINTERVENTIONS.124.013830","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular events still occur at intermediate stenosis with fractional flow reserve (FFR) ≥0.81, underscoring the additional measure to evaluate this residual risk. A reduction in distal coronary artery pressure/aortic pressure (Pd/Pa) from baseline to hyperemia (ie, change in Pd/Pa) reflects lipidic burden within vessel walls. We hypothesized that this physiological measure might stratify the risk of future cardiac events at deferrable lesions.</p><p><strong>Methods: </strong>Lesion- (899 intermediate lesions) and patient-based (899 deferred patients) analyses in those with FFR ≥0.81 were conducted to investigate the association between change in Pd/Pa and target lesion failure (TLF) and major adverse cardiac events at 7 years, respectively.</p><p><strong>Results: </strong>The occurrence of TLF and major adverse cardiac events was 6.7% and 13.4%, respectively. The incidence of target lesion-related nonfatal myocardial infarction was 0.6%. Lesions with TLF had a greater change in Pd/Pa (0.11±0.03 versus 0.09±0.04; <i>P</i>=0.002), larger diameter stenosis (51.0±9.2% versus 46.4±12.4%; <i>P</i>=0.048), and smaller FFR (0.84 [0.82-0.87] versus 0.86 [0.83-0.90]; <i>P</i>=0.02). Change in Pd/Pa (per 0.01 increase) predicted TLF (odds ratio, 1.16 [95% CI, 1.05-1.28]; <i>P</i>=0.002) and major adverse cardiac event (odds ratio, 1.08 [95% CI, 1.01-1.16]; <i>P</i>=0.03). Lesions with change in Pd/Pa ≥0.10 had 2.94- and 1.85-fold greater likelihood of TLF (95% CI, 1.30-6.69; <i>P</i>=0.01) and major adverse cardiac event (95% CI, 1.08-3.17; <i>P</i>=0.03), respectively. Lesions with FFR ≤0.85 had a substantially higher likelihood of TLF when there is a change in Pd/Pa ≥0.10 (12.4% versus 2.9%; hazard ratio, 3.60 [95% CI, 1.01-12.80]; <i>P</i>=0.04). However, change in Pd/Pa did not affect TLF risk in lesions with FFR ≥0.86 (3.8% versus 3.7%; hazard ratio, 0.56 [95% CI, 0.06-5.62]; <i>P</i>=0.62).</p><p><strong>Conclusions: </strong>Despite deferrable FFR values, lesions and patients with a change in Pd/Pa ≥0.10 had higher cardiovascular risk. Change in Pd/Pa might help stratify lesion- and patient-level risks of future cardiac events in those with FFR ≥0.81.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e013830"},"PeriodicalIF":6.1000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404766/pdf/","citationCount":"0","resultStr":"{\"title\":\"Change in Pd/Pa: Clinical Implications for Predicting Future Cardiac Events at Deferred Coronary Lesions.\",\"authors\":\"Kota Murai, Yu Kataoka, Eri Kiyoshige, Takamasa Iwai, Kenichiro Sawada, Hideo Matama, Hiroyuki Miura, Satoshi Honda, Masashi Fujino, Shuichi Yoneda, Kazuhiro Nakao, Kensuke Takagi, Fumiyuki Otsuka, Yasuhide Asaumi, Kunihiro Nishimura, Teruo Noguchi\",\"doi\":\"10.1161/CIRCINTERVENTIONS.124.013830\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Cardiovascular events still occur at intermediate stenosis with fractional flow reserve (FFR) ≥0.81, underscoring the additional measure to evaluate this residual risk. A reduction in distal coronary artery pressure/aortic pressure (Pd/Pa) from baseline to hyperemia (ie, change in Pd/Pa) reflects lipidic burden within vessel walls. We hypothesized that this physiological measure might stratify the risk of future cardiac events at deferrable lesions.</p><p><strong>Methods: </strong>Lesion- (899 intermediate lesions) and patient-based (899 deferred patients) analyses in those with FFR ≥0.81 were conducted to investigate the association between change in Pd/Pa and target lesion failure (TLF) and major adverse cardiac events at 7 years, respectively.</p><p><strong>Results: </strong>The occurrence of TLF and major adverse cardiac events was 6.7% and 13.4%, respectively. The incidence of target lesion-related nonfatal myocardial infarction was 0.6%. Lesions with TLF had a greater change in Pd/Pa (0.11±0.03 versus 0.09±0.04; <i>P</i>=0.002), larger diameter stenosis (51.0±9.2% versus 46.4±12.4%; <i>P</i>=0.048), and smaller FFR (0.84 [0.82-0.87] versus 0.86 [0.83-0.90]; <i>P</i>=0.02). Change in Pd/Pa (per 0.01 increase) predicted TLF (odds ratio, 1.16 [95% CI, 1.05-1.28]; <i>P</i>=0.002) and major adverse cardiac event (odds ratio, 1.08 [95% CI, 1.01-1.16]; <i>P</i>=0.03). Lesions with change in Pd/Pa ≥0.10 had 2.94- and 1.85-fold greater likelihood of TLF (95% CI, 1.30-6.69; <i>P</i>=0.01) and major adverse cardiac event (95% CI, 1.08-3.17; <i>P</i>=0.03), respectively. Lesions with FFR ≤0.85 had a substantially higher likelihood of TLF when there is a change in Pd/Pa ≥0.10 (12.4% versus 2.9%; hazard ratio, 3.60 [95% CI, 1.01-12.80]; <i>P</i>=0.04). However, change in Pd/Pa did not affect TLF risk in lesions with FFR ≥0.86 (3.8% versus 3.7%; hazard ratio, 0.56 [95% CI, 0.06-5.62]; <i>P</i>=0.62).</p><p><strong>Conclusions: </strong>Despite deferrable FFR values, lesions and patients with a change in Pd/Pa ≥0.10 had higher cardiovascular risk. Change in Pd/Pa might help stratify lesion- and patient-level risks of future cardiac events in those with FFR ≥0.81.</p>\",\"PeriodicalId\":10330,\"journal\":{\"name\":\"Circulation: Cardiovascular Interventions\",\"volume\":\" \",\"pages\":\"e013830\"},\"PeriodicalIF\":6.1000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404766/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Cardiovascular Interventions\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCINTERVENTIONS.124.013830\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/25 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.013830","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/25 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：心血管事件仍会发生在分数血流储备（FFR）≥0.81 的中度狭窄处，因此需要额外的措施来评估这一残余风险。远端冠状动脉压力/主动脉压力从基线到高血流状态的降低（即 Pd/Pa 的变化）反映了血管壁内的脂质负荷。我们假设这一生理指标可对可延缓病变处未来发生心脏事件的风险进行分层。研究方法对 FFR ≥0.81 的病变（899 例中间病变）和患者（899 例延期患者）进行分析，分别研究 Pd/Pa 变化与 7 年后靶病变失败（TLF）和主要不良心脏事件（MACE）之间的关系。结果TLF和MACE的发生率分别为6.7%和13.4%。与靶病变相关的非致死性心肌梗死发生率为 0.6%。TLF病变的Pd/Pa变化更大（0.11±0.03 vs. 0.09±0.04；P=0.002），狭窄直径更大（51.0±9.2% vs. 46.4±12.4%；P=0.048），FFR更小（0.84 (0.82-0.87) vs. 0.86 (0.83-0.90)；P=0.02）。Pd/Pa的变化（每增加0.01）可预测TLF（几率比1.16；95% 置信区间（CI），1.05-1.28；P=0.002）和MACE（几率比1.08；95% CI，1.01-1.16；P=0.03）。Pd/Pa变化≥0.10的病变发生TLF（95% CI，1.30-6.69；P=0.01）和MACE（95% CI，1.08-3.17；P=0.03）的可能性分别为2.94倍和1.85倍。当 Pd/Pa 变化≥0.10 时，FFR ≤0.85 的病变发生 TLF 的可能性大大增加（12.4% 对 2.9%；危险比 3.60，95% CI，1.01-12.80；P=0.04）。然而，Pd/Pa的变化并不影响FFR≥0.86的病变的TLF风险（3.8% vs. 3.7%；危险比，0.56；95% CI，0.06-5.62；P=0.62）。结论：尽管FFR值可延缓，但Pd/Pa变化≥0.10的病变和患者的心血管风险较高。Pd/Pa的变化可能有助于对FFR≥0.81的病变和患者未来发生心脏事件的风险进行分层。
Change in Pd/Pa: Clinical Implications for Predicting Future Cardiac Events at Deferred Coronary Lesions.
Background: Cardiovascular events still occur at intermediate stenosis with fractional flow reserve (FFR) ≥0.81, underscoring the additional measure to evaluate this residual risk. A reduction in distal coronary artery pressure/aortic pressure (Pd/Pa) from baseline to hyperemia (ie, change in Pd/Pa) reflects lipidic burden within vessel walls. We hypothesized that this physiological measure might stratify the risk of future cardiac events at deferrable lesions.
Methods: Lesion- (899 intermediate lesions) and patient-based (899 deferred patients) analyses in those with FFR ≥0.81 were conducted to investigate the association between change in Pd/Pa and target lesion failure (TLF) and major adverse cardiac events at 7 years, respectively.
Results: The occurrence of TLF and major adverse cardiac events was 6.7% and 13.4%, respectively. The incidence of target lesion-related nonfatal myocardial infarction was 0.6%. Lesions with TLF had a greater change in Pd/Pa (0.11±0.03 versus 0.09±0.04; P=0.002), larger diameter stenosis (51.0±9.2% versus 46.4±12.4%; P=0.048), and smaller FFR (0.84 [0.82-0.87] versus 0.86 [0.83-0.90]; P=0.02). Change in Pd/Pa (per 0.01 increase) predicted TLF (odds ratio, 1.16 [95% CI, 1.05-1.28]; P=0.002) and major adverse cardiac event (odds ratio, 1.08 [95% CI, 1.01-1.16]; P=0.03). Lesions with change in Pd/Pa ≥0.10 had 2.94- and 1.85-fold greater likelihood of TLF (95% CI, 1.30-6.69; P=0.01) and major adverse cardiac event (95% CI, 1.08-3.17; P=0.03), respectively. Lesions with FFR ≤0.85 had a substantially higher likelihood of TLF when there is a change in Pd/Pa ≥0.10 (12.4% versus 2.9%; hazard ratio, 3.60 [95% CI, 1.01-12.80]; P=0.04). However, change in Pd/Pa did not affect TLF risk in lesions with FFR ≥0.86 (3.8% versus 3.7%; hazard ratio, 0.56 [95% CI, 0.06-5.62]; P=0.62).
Conclusions: Despite deferrable FFR values, lesions and patients with a change in Pd/Pa ≥0.10 had higher cardiovascular risk. Change in Pd/Pa might help stratify lesion- and patient-level risks of future cardiac events in those with FFR ≥0.81.
期刊介绍：
Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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