血管内超声或血流储备分数指导冠状动脉临界病变介入治疗的临床效果

Outcomes of percutaneous coronary intervention for intermediate coronary artery disease guided by intravascular ultrasound or fractional flow reserve

目的：评价在冠脉临界病变患者中，经血管内超声（IVUS）指导介入治疗的患者与经测定血流储备分数（FFR）指导介入治疗的患者的远期临床效果。方法选取冠脉造影证实冠脉狭窄程度40%~70%的患者共226例（293处病变），分为血管内超声指导组98处病变、血流储备分数指导组101处病变、药物治疗组94处病变。在血管内超声指导组中，如狭窄处最小管腔面积（MLA）＜4 mm2行冠脉支架置入术；在血流储备分数组中，如FFR＜0.8予以行介入治疗。术后随访1年，比较3组患者的主要心血管不良事件发生率（死亡、心梗、靶血管重建）。结果（1）3组患者冠脉造影显示的狭窄程度及病变长度无明显差别；（2）血管内超声指导组行冠脉介入治疗术的患者比例高于血流储备分数指导组（P＜0.001）；（3）3组患者的主要心血管不良事件的发生率无明显差别（P=0.182）。结论血流储备分数检测及血管内超声检查均可以用于指导冠脉临界病变的介入治疗策略，血管内超声检查仅依靠单一的测定狭窄处最小管腔面积作为介入治疗的标准可能会增加介入干预患者比例。

Objective To evaluate the long-term clinical outcomes of fractional flow reserve （FFR）-guided versus intravascular ultrasound （IVUS）-guided percutaneous coronary intervention （PCI） for intermediate coronary lesions. Methods A total of 226 patients with 293 intermediate coronary artery lesions （stenosis of 40%-70%） confirmed by coronary angiography were randomized into 3 groups to undergo PCI for a minimal lumen cross sectional area （MLA）〈4 mm2 （IVUS group, 98 lesions） or for a FFR〈0.80 （FFR group, 101 lesions）, or to receive standard medical treatment （medication group, 94 lesions）. The primary outcome was major adverse cardiac events including death, myocardial infarction, and ischemia- driven target vessel revascularization at 1 year after the index procedure. Results The baseline percent diameter stenosis and lesion length were similar between the 3 groups, but more patients in IVUS group than in FFR group received PCI （P〈0.001）. No significant difference was found in the incidence of major adverse cardiac events between the 3 groups （P=0.182）. Conclusions Both FFR-and IVUS-guided PCI strategy for intermediate coronary artery disease are associated with favorable outcomes, but IVUS-guided PCI based on the single index of MLA can increase the rate of revascularization therapy.