血流储备分数在冠状动脉左主干临界病变中的应用

Application of Fractional Flow Reserve in Borderline Lesion of Left Main Coronary Artery

目的分析、比较血流储备分数（FFR）与冠状动脉造影（CAG）在指导冠状动脉左主干临界病变治疗中的应用。方法选择经CAG证实病变程度为冠状动脉左主干临界病变的冠心病患者187例,分为CAG药物治疗组、CAG介入治疗组、FFR药物治疗组、FFR介入治疗组。CAG药物治疗组未行经皮冠状动脉介入（PCI）治疗,仅进行规范的冠心病二级预防药物治疗;CAG介入治疗组根据术者经验及患者临床症状、相关辅助检查决定行PCI治疗;FFR药物治疗组是对FFR〉0.80的病变不进行PCI治疗,而给予规范的冠心病二级预防药物治疗;FFR介入治疗组是对FFR≤0.80的病例行PCI治疗。所有患者均给予最优化的冠心病二级预防药物治疗。术后随访12个月,观察随访期间的主要不良心脏事件（包括心血管病死亡、非致死性心肌梗死、靶血管血运重建）和加拿大心血管病学会（CCS）心绞痛分级情况。结果随访结果发现,4组患者均未发生心血管病死亡和CCSⅣ级的心绞痛发作;与CAG指导下的药物治疗组和介入治疗组比较,FFR指导下的药物治疗组和介入治疗组的非致死性心肌梗死、靶血管血运重建和CCSⅠ~Ⅲ级心绞痛发作情况明显降低,差异有统计学意义（P〈0.05）。结论 FFR在冠状动脉左主干临界病变治疗中有一定指导意义。

Aim To analyze and to compare the application of fractional flow reserve（ FFR） and coronary angiography（ CAG） on instructing the treatment of borderline lesion of left main coronary artery. Methods 187 patients with borderline lesions in left main coronary artery confirmed by the CAG were divided into four groups： CAG medicine treatment group,CAG intervention group,FFR medicine treatment group,FFR intervention group. CAG medicine treatment group was treated merely with optimal secondary prevention medicine for coronary artery disease,but no percutaneous coronary intervention（ PCI）. CAG intervention group accepted PCI according to the operator＇s experience,the patient＇s clinical symptoms and the related auxiliary examination. FFR medicine treatment group was treated with medicine therapy according to FFR value 〉0. 80. FFR intervention group was treated with PCI according to FFR value≤0. 80. All patients were given optimal secondary prevention medicine for coronary heart disease. Main adverse cardiac event（ including cardiovascular death,non-fatal myocardial infarction,target vessel revascularization） and angina pectoris classification of Canadian Cardiovascular Society（ CCS） were analyzed in the 12 months follow-up period. Results The 4 groups had no cardiovascular death and CCS Ⅳ grade angina pectoris attack. Compared with CAG-guided medicine treatment group and intervention group,non-fatal myocardial infarction,target vessel revascularization and CCS Ⅰ ~ Ⅲ grade angina pectoris decreased significantly in FFR-guided medicine treatment group and intervention group（ P〈0. 05）. Conclusion FFR have a certain guiding significanc in the therapy of borderline lesion of left main coronary artery.