During the 5-year follow-up period, both the FFR- and IVUS-guided PCI for intermediate coronary artery disease were associated with favorable outcomes. Both FFR and IVUS are useful additional tests for determining the PCI in patients with intermediate coronary lesions.
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5-year Outcomes of Fractional Flow Reserve-Guided versus Intravascular Ultrasound-Guided Percutaneous
Coronary Intervention in Intermediate Coronary Artery Disease
Choi, Sang Woong Department of Internal Medicine
Graduate School Keimyung University
(Supervised by Professor Nam, Chang Wook)
Both fractional flow reserve (FFR)- and intravascular ultrasound
(IVUS)-guided percutaneous coronary intervention (PCI) strategies were
reported to be safe and effective in intermediate coronary lesions for up
to 1 year of follow-up. This study aimed to investigate whether the
favorable clinical outcomes of the lesions persisted over a 5-year
follow-up. One hundred sixty seven patients, with intermediate coronary
lesions evaluated by FFR or IVUS (FFR guided, 83 lesions vs. IVUS
guided, 94 lesions), were included. The primary end-point was the
patient oriented clinical outcome (POCO), defined as a composite of
cardiac death, nonfatal myocardial infarction (MI), and any revascularization.
(VOCO), defined as a composite of cardiac death, target vessel MI and
ischemia-driven target vessel revascularization. The baseline characteristics
were similar except for more multi-vessel disease and a smaller vessel
diameter in the FFR group. The POCO at 5 years was 12.4% (FFR
10.8% vs IVUS 13.8%, p=ns) and VOCO 11.3% (FFR 12.0% vs IVUS
10.6%, p=ns). The Kaplan-Meier survival analysis of the POCO and
VOCO was similar between the two groups. Both the FFR guided and
IVUS guided PCI strategy for intermediate coronary artery disease were
associated with favorable 5-year clinical outcomes.
중간단계의 관상동맥 협착질환에서 분획 혈류 예비력 유도하 경피적 관상 동맥 중재술과 관상동맥 혈관내 초음파
유도하 경피적 관상동맥 중재술의 5년 임상결과 비교
최 상 웅 계명대학교 대학원 의학과 내과학 전공
(지도교수 남 창 욱)
이전 연구에서, 관상동맥 혈관내 초음파(intravascular ultrasound, IVUS)
및 분획 혈류 예비력(fractional flow reserve, FFR) 유도 경피적 관상동맥
중재술(percutaneous coronary intervention, PCI) 전략 모두 1년 동안의 추
적관찰 동안 중간단계 관상동맥 병변에서 안전하고 효과적이라고 보고되었
다. 이 연구의 목적은 FFR 및 IVUS 유도 PCI의 유리한 임상 결과가 중간
단계 병변에서 5년 동안 지속되는지 조사하는 것이다. FFR 또는 IVUS
(FFR 유도 83 병변 대 IVUS 유도 94 병변)에 의해 평가된 중간단계 관상
동맥 병변을 갖는 167명의 환자가 포함되었다. FFR 군에서 FFR의 컷오프
값은 0.80이었고 IVUS 군에서 최소 내강 단면적에 대한 컷오프 값은 4.0
mm2였다. 연구 일차 종결점은 심장 사망, 비 치명적 심근 경색 및 모든 혈
관 재관류술로 정의된 환자 지향적 임상 결과(patient-oriented clinical
outcome, POCO)였다. 이차 종결점(vessel-oriented clinical outcome,
VOCO)은 심장 사망, 표적 혈관 관련 심근 경색과 허혈 유발에 의한 재관
류술의 복합체로 정의되는 혈관 관련 결과였다. FFR 군에서 다 혈관 질환
이 많고 혈관 직경이 작은 경우를 제외하면 두 군 모두에서 기저 특성이
유사했다. 5년간 POCO는 12.4%(FFR 10.8% 대 IVUS 13.8%, p=ns),
VOCO는 11.3% 였다(FFR 12.0% 대 IVUS 10.6%, p=ns). POCO와 VOCO
의 Kaplan-Meier 생존 분석은 두 군 간에 유사했다. 중간단계 관상동맥 협
착질환에 대한 FFR 유도 및 IVUS 유도 PCI 전략 모두 5년 임상 결과에
유리한 결과를 보였다. 중간단계 관상동맥 협착질환의 PCI 시행 결정에 있
어 FFR 과 IVUS 모두 유용한 검사가 되겠다.
□ 저자 약력
「Spontaneous Coronary Artery Dissection Diagnosed by Intravascular Ultrasound and followed up by Cardiac Computed Tomography」
Korean J Intern Med Vol.28 2013. 5.
「Migration of Atrial Septal Defect Closure Device due to Coughing」계 명의대학술지 Vol.32 No.1 2013. 6.
「경피적 관상동맥 중재술을 시행한 급성 심근경색증 환자에서 저밀도 지 단백 콜레스테롤 수치에 따른 고감도 C반응 단백의 예후 예측능력」계명 대학교 석사학위논문 2013.
「Implication of Ultrasound Contrast Enhancement of Carotid Plaques in Prevalence of Acute Coronary Syndrome and Occurrence of Cardiovascular
「Optical Coherence Tomography: Defined Plaque Erosion after Removal of a Coronary Guidewire」Korean Circ J Vol.49 No.9 2019.