Hirota Minoru, Iwasaki Kohichiro, Yamamoto Keizo, Kusachi Shozo, Hina Kazuyoshi, Hirohata Satoshi, Murakami Masaaki, Kamikawa Shigeshi, Murakami Takashi, Shiratori Yasushi
Department of Medicine and Medical Science, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
Coron Artery Dis. 2006 Mar;17(2):181-6. doi: 10.1097/00019501-200603000-00013.
No reliable methods are available for determining application of percutaneous coronary intervention for treatment of equivocal tandem lesions. We investigated whether coronary pressure measurement is useful for determining the lesion that requires percutaneous coronary intervention in tandem lesions.
We measured coronary pressure in 72 consecutive patients with tandem lesions. Myocardial fractional flow reserve (FFRmyo) was obtained as the ratio of coronary pressure distal to the lesion/aortic pressure under maximal hyperemia. If the FFRmyo across the tandem lesions was >or=0.75, we deferred percutaneous coronary intervention for the lesion. When the tandem lesions showed FFRmyo<0.75, percutaneous coronary intervention was performed on the lesion that showed angiographically higher stenosis. When FFRmyo was <0.75 after one-lesion percutaneous coronary intervention, this intervention was carried out on the remaining lesion.
We deferred percutaneous coronary intervention for 26 patients (36.1%), and performed percutaneous coronary intervention in 46 patients (63.8%). We performed percutaneous coronary intervention for one lesion in 19 patients (26.4%) and for both lesions in 27 patients (37.5%). Among patients in whom percutaneous coronary intervention was deferred, only two patients (7.7%) required target lesion revascularization during the follow-up period. This rate was not higher than that in the 46 patients who underwent percutaneous coronary intervention for one or two lesions (six patients, 13.0%). Similarly, the target lesion revascularization in lesions with initially deferred percutaneous coronary intervention (5.6%, 4/71 lesions) was not higher than that in lesions with percutaneous coronary intervention (15.1%, 11/73 lesions). Major cardiac events, cardiac death and acute myocardial infarction, did not occur in patients with deferred percutaneous coronary intervention and in those with percutaneous coronary intervention during the follow-up period.
Our results clearly showed that coronary pressure measurement was clinically useful for identifying equivocal tandem lesions requiring percutaneous coronary intervention.
目前尚无可靠方法来确定经皮冠状动脉介入治疗在模棱两可的串联病变中的应用。我们研究了冠状动脉压力测量对于确定串联病变中需要经皮冠状动脉介入治疗的病变是否有用。
我们对72例连续的串联病变患者进行了冠状动脉压力测量。心肌血流储备分数（FFRmyo）通过病变远端冠状动脉压力与最大充血时主动脉压力的比值获得。如果串联病变的FFRmyo≥0.75，我们推迟对该病变进行经皮冠状动脉介入治疗。当串联病变的FFRmyo<0.75时，对血管造影显示狭窄程度更高的病变进行经皮冠状动脉介入治疗。当一处病变经皮冠状动脉介入治疗后FFRmyo<0.75时，对剩余病变进行该介入治疗。
我们推迟了26例患者（36.1%）的经皮冠状动脉介入治疗，对46例患者（63.8%）进行了经皮冠状动脉介入治疗。我们对19例患者（26.4%）的一处病变进行了经皮冠状动脉介入治疗，对27例患者（37.5%）的两处病变进行了治疗。在推迟经皮冠状动脉介入治疗的患者中，只有2例患者（7.7%）在随访期间需要进行靶病变血管重建。该比率不高于对一处或两处病变进行经皮冠状动脉介入治疗的46例患者中的比率（6例患者，13.0%）。同样，最初推迟经皮冠状动脉介入治疗的病变中的靶病变血管重建率（5.6%，4/71处病变）不高于进行经皮冠状动脉介入治疗的病变中的比率（15.1%，11/73处病变）。在随访期间，推迟经皮冠状动脉介入治疗的患者和进行经皮冠状动脉介入治疗的患者均未发生主要心脏事件、心源性死亡和急性心肌梗死。
我们的结果清楚地表明，冠状动脉压力测量在临床上有助于识别需要经皮冠状动脉介入治疗的模棱两可的串联病变。
