Long-Term Clinical Outcomes Of Fractional Flow Reserve-Guided Coronary Artery Revascularization in Chronic Kidney Disease Ⅱ
Jan 18, 2024
3. Cov txiaj ntsig
3.1. Tus neeg mob thiab tus yam ntxwv ntawm lub nkoj
Cov yam ntxwv ntawm cov neeg mob thiab cov hlab ntsha tau sau tseg hauv Table 1. Ntawm 242 tus neeg mob, ib feem peb yog poj niam, 90% muaj cov hlab ntsha uas muaj qhov nruab nrab stenosis, thiab 44% muaj cov hlab ntsha uas muaj FFR tsawg dua lossis sib npaug. {{10}}.8. Cov neeg mob feem ntau muaj CAD ruaj khov, thiab 27% ntawm cov neeg mob tau txais kev lim ntshav mus ntev. Piv nrog rau pawg tsis-revascularization (FFR> 0.8), pawg revascularization (FFR Tsawg dua lossis sib npaug rau 0.8) muaj ntau qhov sib txawv ntawmplawv tsis ua hauj lwmthiabKev lim ntshav-dependent CKD, ntau dua CAD, thiab ntau lub hom phiaj ntawm cov hlab ntsha ntawm sab laug lub ntsiab lossis ostium / ze ze ntawm sab laug anterior descending artery, uas sawv cev rau qhov kev hem thawj loj rau myocardium. Kaum tus neeg mob nrog 12 lub nkoj (9.5% ntawm pawg revascularization) nrog lub sijhawm FFR ntawm 0.77–{5}}.80 ( nruab nrab: 0.80 ± 0.0025 ) tau txais kev kho mob nkaus xwb. Ntawm qhov seem 114 cov hlab ntsha hauv pab pawg revascularization, feem ntau cov neeg mob tau txais PCI thiab tsuas yog 2% tau txais kev phais mob plawv bypass grafting. Ze li ntawm ob feem peb ntawm cov neeg mob nrog PCI tau txais kev siv tshuaj-eluting stent lossis bioresorbable vascular scaffold implantation. FFR-coj cov tswv yim tswj xyuas tau sau tseg nyob rau hauv Table 2. Lub sij hawm nruab nrab ntawm kev soj ntsuam yog luv dua nyob rau hauv pab pawg revascularization dua li nyob rau hauv pawg non-revascularization (2.6 xyoo vs. 3.2 xyoo).
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Table 1. Lub hauv paus thiab lub hom phiaj lub nkoj yam ntxwv ntawmcov neeg mob nrog CKDuas tau txais kev kuaj FFR ntawm NTUH, stratified los ntawm FFR Tsawg dua lossis sib npaug rau {{0}}.8 (revascularization) thiab FFR > 0.8 (non-revascularization).
Cov ntawv luv: CAD, kab mob plawv; CKD, mob raum mob; FFR, ua haujlwm txaus cia; HbA1C, hemoglobin A1c; LDL, qis lipoprotein tsawg; LVEF, sab laug ventricular ejection feem; NTG-Pd / Pa, nitroglycerine induced acute poob ntawm txhais tau tias distal siab / txhais tau tias proximal siab; NTUH, National Taiwan University Hospital. * suav raws li ib lub nkoj, txwv tsis pub suav raws li tus neeg mob. † Cov kab mob sib kis tau txhais tias yog stenosis uas muaj ntau tshaj ib ntu. ‡ Cov kab mob tandem tau txhais tias yog ob qhov sib cais stenoses nyob rau hauv tib lub coronary artery, sib cais los ntawm ib qho angiographically ib txwm ntu.
3.2. Cov txiaj ntsig kho mob
Thawj qhov kawg ntawm pawg revascularization yog siab dua li ntawm pawg nonrevascularization (25.5% vs. 13.2%; kho qhov phom sij piv[aHR], 2.06; 95% kev ntseeg siab luv [CI], 1.07–3.97; p {{11} }.030) ntawm qhov nruab nrab ua raws li 2.9 xyoo. Tsis tas li ntawd, 90.5% ntawm cov neeg mob nyob rau hauv cov pab pawg neeg revascularization tau txais coronary revascularization (Table 3). Cov txiaj ntsig no tau zoo ib yam thaum stratified raws li CKD qhov hnyav (Table 4). Lub hom phiaj ntawm lub nkoj tsis ua hauj lwm kuj tseem siab dua nyob rau hauv pab pawg revascularization ntau dua li hauv pawg uas tsis yog revascularization (17.5% vs. 8.3%; aHR, 2.19; 95% CI, 1.10–4.37; p=0.026). Lwm qhov kawg ntawm qhov kawg tsis sib txawv ntawm ob pawg (Table 3). Lub Kaplan–Meier nkhaus rau thawj qhov kawg thiab qhov tseem ceeb thib ob qhov kawg yog qhia hauv daim duab 2.
Rooj 2. Tshuaj thaum tso tawm thiabrevascularization tswv yimntawmcov neeg mob nrog CKDWHOtau txais kev kuaj FFRntawm NTUH, stratified los ntawm FFR Tsawg dua los yog sib npaug rau {{0}}.8 (revascularization) thiab FFR > 0.8 (non-revascularization).
3.3. Tus nqi kwv yees thiab txiav tawm zoo tshaj plaws ntawm FFR los kwv yees cov txiaj ntsig kho mob
Lub cheeb tsam nyob rau hauv lub sij hawm-dependent receiver kev khiav hauj lwm tus yam ntxwv nkhaus yog 0.70 thaum siv FFR los kwv yees lub ntsiab qhov kawg. Qhov kev txiav tawm zoo tshaj plaws ntawm FFR hauv kev kwv yees thawj qhov kawg ntawm 1 xyoo yog 0.78, nrog thaj tsam nyob rau hauv lub sij hawm-dependent receiver kev khiav hauj lwm tus yam ntxwv nkhaus ntawm 0.72, thiab qhov tseeb ntawm 70% (rhiab heev 75%, spec infinity 69%, tsis zoo kwv yees tus nqi
4. Kev sib tham
Rau peb txoj kev paub, qhov no yog thawj txoj kev tshawb fawb los ntsuas qhov kev sib raug zoo ntawm coronary invasive physiologic index thiab cardiovascular cov txiaj ntsig hauv CKD cov pej xeem, nrog rau cov neeg mob ntshav qab zib CKD. Txoj kev tshawb no tau pom tias kev ua haujlwm ntawm ischemia hauv coronary stenosis tau cuam tshuam nrog kev pheej hmoo siab dua ntawm cov txiaj ntsig ntawm lub plawv tuag, tsis tuag myocardial infarction, thiab ischemia-driven revascularization. Cov txiaj ntsig no tau zoo ib yam ntawm qhov sib txawv CKD qhov hnyav. Tsis tas li ntawd, qhov tseeb ntawm FFR hauv kev kwv yees qhov txiaj ntsig sib xyaw no
Hauv Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 2 txoj kev tshawb fawb, FFR-guided PCI lub tswv yim tau cuam tshuam nrog qis MACE cov txiaj ntsig tom qab 5 xyoos dua li cov neeg mob uas muaj kev ua haujlwm ischemia uas tau txais kev kho mob ib leeg. FFR-coj PCI kuj tau pom qhov txiaj ntsig tsis zoo ntawm MACE piv rau cov neeg mob uas muaj hemodynamic tseem ceeb stenosis thiab kev kho mob ib leeg [10]. Txawm li cas los xij, tsuas yog 2% ntawm cov pej xeem CKD tau tshaj tawm hauv kev sim ua ntej. Peb txoj kev tshawb fawb tau pom qhov txiaj ntsig ntawm MACE ntau dua nyob rau hauv pab pawg ischemia ua haujlwm ntau dua li ntawm pawg tsis yog ischemia, thiab qhov txiaj ntsig no tau zoo ib yam ntawm qhov sib txawv ntawm CKD. Qhov tsis ua tiav ntawm coronary revascularization hauv kev txo qis MACE tuaj yeem yog vim ob peb yam. Ua ntej, residual ischemia, txij li cov kab mob diffuse thiab tandem yog qhov tseem ceeb hauv pawg ischemia ua haujlwm; Kev ntsuam xyuas tom qab PCI FFR niaj hnub yuav tsum tau txiav txim siab hauv cov xwm txheej zoo li no kom tsis suav nrog qhov muaj feem cuam tshuam ntawm ischemia [16,17]. Qhov tseem ceeb, tsuas yog 39% ntawm post-PCI FFR muaj nyob rau hauv pawg revascularization hauv txoj kev tshawb no (cov ntaub ntawv tsis qhia). Tsis tas li ntawd, kev ntsuam xyuas coronary flow reserve kuj tseem raug txiav txim siab vim qhov muaj feem ntau ntawm microvascular tsis ua haujlwm hauv CKD cov pej xeem, uas tuaj yeem cuam tshuam qhov tseeb ntawm FFR hauv cov xwm txheej no [11,18]. Qhov thib ob, kev nrawm atherosclerosis tsis yog qhov tsis tshua muaj nyob rau hauv cov tswv yim revascularization siab. Ib feem peb ntawm cov hlab ntsha ischemic nyob rau hauv txoj kev tshawb no tau txais ib tug liab-hlau stent implantation los yog balloon angioplasty ib leeg, uas tej zaum yuav pab tau rau lub unfavorable tshwm sim nyob rau hauv cov pab pawg neeg ischemic (Sab ntxiv Table S1). Tsis tas li ntawd, optimization ntawm kev pheej hmoo ntawm cov hlab plawv thiab kev ua kom qeebkev loj hlob ntawm lub raum kab mobhauvmob me theem ntawm CKDtau tawm tswv yim. Accelerated atherosclerosis feem ntau yog tsim nyob rau hauv CKD siab heev, thiab tsis muaj cov plaque modifiers zoo nyob rau theem no [19].
Hauv kev sim ISCHEMIA-CKD, tsuas yog 50% ntawm revascularization tau ua nyob rau hauv pawg invasive, thiab kwv yees li ib feem peb ntawm cov neeg mob nyob rau hauv pawg invasive muaj cov kab mob uas tsis yog-obstructive coronary. Cov txiaj ntsig no txhais tau hais tias yog qhov tseeb ntawm kev kuaj lub cev tsis muaj zog lossis qhov muaj feem ntau ntawm cov kab mob microvascular yog ib qho kev txhawj xeeb hauv CKD [5]. Ib yam li ntawd, qhov tseeb ntawm FFR kev ntsuam xyuas los ntsuas qhov tseem ceeb ntawm hemodynamic ntawm coronary stenosis hauv CKD cov pej xeem kuj xav tau cov ntaub ntawv ntxiv, vim tias submaximal hyperemia tuaj yeem tshwm sim nrog microvascular dysfunction. Qhov sib piv tam sim no tsis muaj nthwv dej, qhov ntsuas tsis yog qhov ntsuas lub cev tsis zoo uas tsis muaj kev ywj pheej ntawm cov kab mob microvascular lar, tsis sib haum nrog FFR tshwm sim hauv cov neeg mob uas muaj hemodialysis [20]. Peb pab pawg tshawb fawb tsis ntev los no pom lwm qhov cuam tshuam ntawm lub cev qhov ntsuas, nitroglycerine-induced mob hnyav poob ntawm Pd / Pa, kom tsis txaus rau FFR tus nqi thaum tsis zoo.lub raum ua haujlwm[21]. Raws li cov ntaub ntawv txwv, peb xav tias qhov kev txiav tawm zoo tshaj plaws ntawm FFR, qhov sib piv tam sim tsis muaj nthwv dej, lossis nitroglycerine-induced acute poob ntawm Pd / Pa yuav txawv ntawm CKD thiab cov neeg tsis yog CKD. Txoj kev tshawb no pom tias qhov zoo tshaj plaws FFR txiav tawm tus nqi hauv kev kwv yees MACE cov txiaj ntsig yog 0.78. Hauv kev sib piv, Johnson et al. [22] tau hais tias qhov zoo tshaj plaws FFR qhov pib rau MACE cov txiaj ntsig yog 0.67 hauv kev ntsuas tus neeg mob qib meta. Txawm li cas los xij, hauv pawg neeg mob ntshav qab zib, uas feem ntau muaj qhov tshwm sim ntau dua ntawm microvascular dysfunction thiab cov txiaj ntsig MACE tsis zoo, qhov pib nce mus rau 0.79, uas zoo ib yam li qhov pib ntawm CKD cov pej xeem hauv txoj kev tshawb no [22]. Txawm li cas los xij, peb qhov kev tshawb fawb me me, thiab cov kev tshawb fawb loj dua yuav tsum tau ntsuas qhov raug thiab txiav tawm ntawm FFR qhov tseem ceeb los kwv yees cov txiaj ntsig kho mob hauv CKD cov pej xeem.
Muaj ob peb qhov kev txwv hauv peb txoj kev kawm. Ua ntej, qhov no yog ib qho kev tshawb nrhiav rov qab los uas tsuas yog kev sib koom ua ke, tsis yog ua rau muaj pov thawj; Yog li ntawd, peb cov kev tshawb pom yuav tsum tau txhais nrog ceev faj. Qhov thib ob, kev xaiv tsis ncaj ncees, qhov tsis txaus ntseeg ntawm qhov tsis txaus ntseeg, thiab kev tsis ncaj ncees ntawm kev ciaj sia tuaj yeem tshwm sim vim tias tsuas yog muaj sia nyob, cov neeg mob tawm mus. Thib peb, mob plawv tuag pab rau ib feem peb ntawm tag nrho cov neeg tuag; tus nqi no tau qis dua li hauv daim ntawv tshaj tawm dhau los [5]. Txhawm rau kom ze rau qhov tseeb, peb tau tshuaj xyuas cov kab kos kho mob thiab rov lees paub daim ntawv tshaj tawm los ntawm Taiwan National Death Registry.
5. Cov lus xaus
FFR yog ib qho kev ntsuas txhim khu kev qha los coj cov tswv yim kho mob rau cov neeg mob CKD, nrog rau cov neeg mob uas muaj kev lim ntshav-dependent CKD vim nws ua rau cov txiaj ntsig kho mob. Txawm li cas los xij, FFR-guided coronary revascularization lub tswv yim tsis tau hloov kho qhov tshwm sim tsis zoo ntawm ischemia hauv txoj kev tshawb no, tej zaum ib feem tau piav qhia los ntawm feem pua ntawm cov neeg mob tau kho nrog cov hlau liab qab stent lossis balloon angioplasty ib leeg.
Cov Khoom Siv Ntxiv: Cov hauv qab no muaj nyob hauv online ntawm https://www.mdpi.com/article/ 10.3390/jpm12010021/s1, Table S1: Qhov tshwm sim ntawm qhov tshwm sim ntawm kev kho mob thiab kev phom sij txaus ntshai ntawm cov tswv yim sib txawv revascularization hauv pawg ischemia ua haujlwm. Sau Kev Koom Tes: Kev Ntseeg, C.-BJ thiab J.-WC; methodology, C.-BJ, T.-SL thiab J.-WC; software, T.-SL; validation, C.-BJ, PY-TL thiab J.-WC; kev tsom xam, T.-SL; kev tshawb nrhiav, C.-BJ, PY-TL, J.-WC, C.-CH thiab H.-LK; Resources, C.-BJ, PY-TL, J.-WC, C.-CH thiab H.-LK; cov ntaub ntawv curation, C.-BJ thiab PY-TL; kev sau ntawv-kev npaj ua ntej, C.-BJ thiab T.-SL; sau-saib thiab kho, C.-BJ, T.-SL, PY-TL, J.-WC, C.-CH thiab H.-LK; kev pom, C.-BJ thiab J.-WC; saib xyuas, C.-BJ thiab J.-WC; project tswj, C.-BJ thiab J.-WC; Kev nrhiav nyiaj txiag, C.-BJ thiab J.-WC Txhua tus kws sau ntawv tau nyeem thiab pom zoo rau cov ntawv luam tawm ntawm cov ntawv sau.
Cov ntaub ntawv
1. Kev sib koom tes ntawm GBD Chronic Kidney Disease. Ntiaj teb no, lub regional, thiab lub teb chaws lub nra ntawm lub raum mob, 1990-2017: AKev tshuaj xyuas qhov systematic rau Kev Tshawb Fawb Ntiaj Teb Kev Tshawb Fawb Txog Kab Mob 2017.Lancet2020, 395, 709–733. [CrossRef]
2. Wen, CP; Cheng, TYD; Tsai, MK; Chang, YC; Chan, HT; Tsai, SP; Chiang, PH; Hsu, CC; Sung, PK; Xu, YH; ua al.Txhua qhov ua rau tuag vim muaj kab mob raum ntev: Txoj kev tshawb fawb yav tom ntej raws li 462,293 tus neeg laus hauv Taiwan.Lancet2008, 371, 2173–2182. [CrossRef]
3. Chou, M.-T.; Wang, J.-J.; Sun, Y.-M.; Xu, M.-J.; Chaw, C.-C.; Weng, S.-F.; Chio, C.-C.; Kan, W.-C.; Chiv, C.-C. Kab mob sib kisthiab kev tuag ntawm cov neeg mob dialysis nrog mob coronary syndrome: Taiwan National Cohort Study.Int. J. Cardiol.2013, 167, 2719–2723. [CrossRef] [PubMed]
4. Mus, AS; Chertow, GM; Fan, D.; McCulloch, CE; Xu, C.-Y. Cov kab mob hauv lub raum ntev thiab kev pheej hmoo ntawm kev tuag, mob plawvxwm txheej, thiab pw hauv tsev kho mob.N. Eng. J. Med.2004, 351, 1296–1305. [CrossRef]
5. Bangalore, S.; Maron, DJ; O'Brien, NWS; Fleg, JL; Kretov, EJ; Briguori, C.; Kaul, UA; Reynolds, HR; Mazurek, T.; Sidhu, MS;ua al. Kev tswj cov kab mob coronary hauv cov neeg mob uas muaj mob raum siab.N. Engl. J. Med.2020, 382, 1608–1618. [CrossRef] [PubMed]
6. Bangalore, S. Kev ntsuam xyuas kev ntxhov siab hauv cov neeg mob uas muaj kab mob raum ntev: Qhov xav tau rau cov cim tseem ceeb rau kev pheej hmoo stratificationthiab kev kwv yees.J. Nucl. Cardiol.2016, 23, 570–574. [CrossRef] [PubMed]
7. Pijls, NH; van Son, JA; Kirkeide, RL; De Bruyne, IB; Gould, KL Kev sim hauv paus ntawm kev txiav txim siab siab tshaj plaws coronary,myocardial, thiab collateral ntshav ntws los ntawm kev ntsuas siab rau kev ntsuas kev ua haujlwm stenosis hnyav ua ntej thiab tom qabpercutaneous transluminal coronary angioplasty.Kev ncig1993, 87, 1354–1367. [CrossRef]
8. Neeb, FJ; Sousa-Uva, M.; Ohlsson, UA; Alfonso, F.; Kev txwv, AP; Benedetto, UA; Byrne, RA; Collet, JP; Falk, V.; Head, SJ;ua al. 2018 ESC/EACTS Cov Lus Qhia ntawm myocardial revascularization.Eur. Lub plawv J.2019, 40, 87–165. [CrossRef]
9. Pijls, NH; Fearon, WF; Tonino, PA; Siebert, UA; Ib, F.; Bornschein, IB; van't Veer, M.; Klaus, V.; Manoharan, G.; Engstrøm, T.;ua al. Fractional flow reserve tiv thaiv angiography rau kev taw qhia percutaneous coronary intervention nyob rau hauv cov neeg mob nrog multivesselTus kab mob coronary artery: 2- xyoo rov qab los ntawm FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation)kawm.J. Am. Col. Cardiol.2010, 56, 177–184. [CrossRef]
10. Xaplanteris, P.; Fournier, S.; Pijls, NH; Fearon, WF; Barbato, E.; Tonino, PA; Engstrøm, T.; Kaab, S.; Dambrink, J.-H.; Rioufol, G.;ua al. Tsib-xyoo cov txiaj ntsig nrog PCI coj los ntawm cov nyiaj seem tshuav.N. Engl. J. Med.2018, 379, 250–259. [CrossRef]
