稳定型冠心病的诊断和治疗：从循证医学到临床指南精选.ppt

男性，48岁，下壁心梗3周，LCX 介入失败 DEFER FAME FAME Outcome Angiography Guided FFR Guided Difference (95% CI) MACEs, % 18.3 13.2 5.2 (0.7–9.7) MI, % 8.7 5.7 3.0 (–0.2–6.2) Death, % 3.0 1.8 1.3 (–0.6–3.2) MI or death, % 11.1 7.3 3.8 (0.3–7.4) QALY 0.838 0.853 0.015 (–0.008–0.037) $ of initial procedure 6007 5332 $ of initial hospitalization 14 878 13 182 –1697 (–2893––510) $ of events during 12-mo f/u 1821 1134 –668 (–1383––25) Overall $ 16 700 14 315 –2384 (–3826––1011) 3-VD 14% 1-VD 34% 2-VD 43% 0-VD 9% Proportions of functionally diseased coronary arteries in patients with angiographic 3-vessel disease (n=115) FAME: Angiography versus FFR Tonino, et al. JACC 2010 FFR-guided SYNTAX Score (FSS) versus Conventional SYNTAX Score (SS) LOW risk 33% MEDIUM risk 33% HIGH risk 33% LOW risk 59 % MEDIUM risk 21% HIGH risk 21% FSS SS 32% of patients moved to a lower-risk group 497 patients of the FFR-arm of FAME Nam, et al. JACC 2011 SYNTAX score Functional SYNTAX score Low Medium High p Value Low Medium High p Value Death 1 (0.6) 3 (1.8) 5 (3.1) 0.24 1 (0.3) 5 (4.7) 3 (3.0) 0.01 MI 8 (4.8) 7 (4.2) 15 (9.2) 0.11 13 (4.5) 4 (3.8) 13 (12.9) 0.005 Repeat PCI / CABG 6 (3.6) 7 (4.2) 17 (10.4) 0.02 13 (4.5) 4 (3.8) 13 (12.9) 0.005 Death / MI 9 (5.4) 10 (6.0) 19 (11.7) 0.06 14 (4.8) 8 (7.5) 16 (15.8) 0.005 MACE 14 (8.4) 17 (10.2) 34 (20.9) 0.001 26 (9.0) 12 (11.3) 27 (26.7) 0.001 FSS vs. SS and Clinical Outcome 497 patients of the FFR-arm of FAME Nam, et al. JACC 2011 FAME II: Inclusion Criteria Patients with stable angina or, stabilized angina pectoris or, atypical chest pain or no chest pain but with documented silent ischemia at least one stenosis is present of at least 50% in one major native epicardial coronary artery and supplying viable myocardium Eligible for PCI Signed written informed consent NCFAME II: Study Flow Pts w/ stable agina or silent ischemia scheduled for 1, 2 or 3 vessel DES stenting OMT PCI + OMT Enrollment stopped due to more MACEs in OMT a