PCI和药物治疗血流储备分数处于临界值的单纯左前降支近端中度狭窄效果的比较

Comparison of PCI and medical treatment for moderate stenosis in isolated proximal left anterior descending coronary artery patients with fractional flow reserve at critical value

目的：探讨血流储备分数（ FFR）处于临界值的单纯左前降支近端中度狭窄患者治疗方案的选择。方法：选择50例冠状动脉造影显示单纯左前降支近端中度狭窄（50％～70％）且FFR处于临界值（0．75～0．80）的患者，分为两组，一组行经皮冠状动脉介入（ PCI）治疗，另一组行药物保守治疗。随访2 a，观察两组患者主要不良心血管事件（心源性猝死、非致死性心肌梗死、再行PCI）的发生率及2 a后左前降支近端的狭窄程度。结果：PCI治疗组和药物治疗组主要不良心血管事件的发生率分别为9．1％（2/22）和10．7％（3/28），差异无统计学意义（P ＞0．999）；2 a后血管狭窄程度分别降低了（9±2）％和（8±3）％，差异亦无统计学意义（t＝0．492，P＞0．05）。结论：FFR处于临界值的单纯左前降支近端中度狭窄患者介入治疗和药物保守治疗的近期预后无差别。

Aim：To compare the efficacy of PCI and medical treatment for moderate stenosis in isolated proximal left anterior descending coronary artery patients with fractional flow reserve at critical value .Methods：Fifty patients, who had isolated proximal left anterior descending coronary artery moderate stenosis （ 50%-70%） with intermediate fractional flow reserve between 0.75 and 0.80, were enrolled.Twenty-two patients（PCI group） were treated with PCI combined with opti-mal medical therapy , and the other 28 patients （ medical-therapy group ） were treated by optimal medical therapy .After a 2-year follow-up, the occurrence of the major adverse cardiovascular events （ MACE） and the stenosis rate of the proximal left anterior descending coronary artery were observed .Results：The occurrence of MACE of PCI group and the medical-thera-py group was 9.1%and 10.7%, the stenosis rates decreased by （9 ±2）%and （8 ±3）%,and there were no differences between the two groups（t=0.492,P〉0.05）.Conclusion：For patients with moderate stenosis and intermediate fractional flow reserve（0.75-0.80）, there is no difference in efficacy of PCI and medical-therapy.