血流储备分数在指导冠状动脉多支病变治疗策略中的作用

Role of fractional flow reserve in guiding percutaneous coronary intervention in patients with multivessel coronary disease

目的评估冠状动脉造影筛选的冠状动脉多支病变与心肌缺血的关系,阐明血流储备分数(FFR)在指导冠状动脉多支病变治疗策略中的作用。方法纳入96例患者218处冠状动脉病变,根据FFR值分为两组,FFR>0.80组(113处)及FFR≤0.80组(105处)。结果 FFR≤0.80组冠状动脉直径狭窄程度更高[(66.2±10.5)%比(59.1±13.8)%,P<0.001]、面积狭窄百分比更大[(87.3±7.7)%比(81.4±10.9)%,P<0.001]、最小管腔直径更小[(0.86±0.36)mm比(1.18±0.49)mm,P<0.001],上述指标与FFR值无明确相关(相关系数分别为r=-0.286,P<0.001;r=-0.282,P<0.001)。冠状动脉最小管腔直径与FFR值呈正相关(r=0.364,P<0.001)。冠状动脉造影筛选的96例患者中,26例为三支病变,70例为双支病变;经FFR测量后,缺血相关的三支病变10例,两支病变29例,单支病变17例。QCA冠状动脉造影直径狭窄≥70%,FFR>0.80的病变为21处(9.6%);QCA冠状动脉造影直径狭窄<70%,FFR≤0.80的病变为53处(24.3%)。QCA冠状动脉造影直径狭窄≥70%,FFR≤0.80的病变为52处(23.9%)(Matches);QCA冠状动脉造影直径狭窄<70%,FFR>0.80的病变为92处(42.2%)(Matches)。QCA冠状动脉造影面积狭窄≥70%,FFR>0.80的病变为89处(40.8%)(Mismatches);QCA冠状动脉造影面积狭窄≥70%,FFR≤0.80的病变为105处(48.2%)(Matches);QCA冠状动脉造影面积狭窄<70%,FFR>0.80的病变为24处(11.0%)(Matches)。结论 FFR在指导冠状动脉多支病变治疗策略中具有重要意义,可显著降低缺血相关靶病变个数。

Objective To explore the correlation between quantitative coronary angiography（QCA） parameters and fractional flow reserve （FFR） value. To illustrate the role of FFR in guiding PCI in patients with multivessel coronary artery disease. Methods This study included 96 patients with 218 coronary artery lesions. Patients were divided into two groups： FFR 〉 0.80 （n = 113 ） or FFR ≤0. 80 （n = 105 ）. Results There were significant statistical difference of percentage diameter stenosis [ （ 59. 1% ±13.8% ） vs. （66.2% ±10.5%, P〈0.001] and percentage areastenosis [（81.4% ±10.9%） vs. （87.3% ±7.7%, P 〈 0. 001 ] between groups. Percentage diameter stenosis and percentage area stenosis were not correlated with FFR value （ r=-0. 286, P 〈 0. 001, r = - 0. 282, P 〈 0. 001 ）. The minimum luminal diameter was statistically different between groups [ （ 1.18±0. 49 ）mm vs. （ 0. 86 ± 0. 36 ） mm, P 〈 0. 001 ] and positively correlated with FFR value （r =0. 364 ,P 〈0. 001 ）. QCA detected 26 patients with three vessel disease and 70 patients with two vessel disease. However, FFR value suggested that only 10 patients had three vessel disease, 29 patients had two vessel disease and 17 patients had one vessel disease. Mismatches and reverse mismatches between diameter stenosis（QCA） and FFR value were 21 （9. 6% ）, 53 （24. 3% ）, respectively. Mismatches between area stenosis （QCA） and FFR value was 89 （40. 8%）. Conclusions FFR measurement in patients with multivesselcoronary disease significantly reduces target lesions when compared with standard angiography-guidedPCI.