目的 系统评价血流储备分数(FFR)指导的冠状动脉粥样硬化性心脏病(冠心病)患者冠状动脉(冠脉)血运重建的经济有效性.方法 通过检索PubMed、Web of science、Embase数据库,筛选从建库至2022年5月1日进行的FFR与冠脉造影术(CAG)指导的冠脉血运重建经济有效性的临床随机对照研究(RCT),进行Meta分析.结果 共计7篇研究被纳入,CAG指导的血运重建组共计1465例,FFR指导的血运重建组共计1490例.对于有冠脉血运重建指征的患者,CAG指导的血运重建与FFR指导的血运重建两组在主要心血管不良事件(MACE)或主要心脑血管不良事件(MACCE)(RR=1.06,95%CI:0.90~1.25)、全因死亡(RR=1.18,95%CI:0.88~1.58)、心肌梗死(RR=1.11,95%CI:0.82~1.50)、再次血运重建(RR=1.03,95%CI:0.83~1.26)发生率无明显差异;在血运重建策略选择了冠脉介入治疗(PCI)的患者中,相较于CAG指导的PCI,FFR指导的PCI减少了平均每例患者的支架植入数(WMD=0.64,95%CI:0.33~0.94).结论 FFR指导的血运重建策略,不增加患者的主要心血管不良事件或主要心脑血管不良事件、全因死亡、心肌梗死、再次血运重建的发生率,具有一定的安全性.其中经FFR 指导采取的PCI可减少平均支架植入数,具有良好的经济有效性,值得推广应用.
Objective To systematically evaluate the economic effectiveness of coronary revascularization in patients with coronary heart disease guided by Fractional flow reserve(FFR).Methods By searching PubMed,Web of Science,and Embase databases,randomized controlled clinical studies(RCTS)on the economic effectiveness of coronary revascularization guided by FFR and coronary angiography(CAG)from the establishment of the database to May 01,2022 were screened for meta-analysis.Results A total of seven studies were included,including 1465 patients in the angiography-guided revascularization group and 1490 patients in the Fractional flow reserve-guided revascularization group.For patients with indications of coronary revascularization,CAG-guided revascularization versus FFR-guided revascularization had no significant differences in MACE or MACCE(RR=1.06,95%CI:0.90~1.25)and all-cause death(RR=1.18,95%CI:0.88~1.58),myocardial infarction(RR=1.11,95%CI:0.82~1.50),and revascularization(RR=1.03,95%CI:0.83~1.26)had no significant difference.Among patients who chose coronary intervention(PCI)as their revascularization strategy,FFR-guided PCI reduced the average number of stents per patient compared to CAG-guided PCI(WMD=0.64,95%CI:0.33~0.94).Conclusion Revascularization strategies guided by FFR do not increase the incidence of MACE or MACCE,all-cause death,myocardial infarction,and revascularization in patients,and are safe to a certain extent.FFR-guided PCI can reduce the average number of stent implantation in patients and has good economic effectiveness,which is worthy of promotion and application.