Lindstaedt Michael, Yazar Aydan, Germing Alfried, Fritz Markus K, Holland-Letz Tim, Mügge Andreas, Bojara Waldemar
Medical Clinic II, University Hospital Bergmannsheil, Bochum, Germany.
Am Heart J. 2006 Jul;152(1):156.e1-9. doi: 10.1016/j.ahj.2006.03.026.
Correct assessment of the significance of left main stem lesions is of pivotal importance to the patient with coronary artery disease. On the basis of clinical and angiographic information alone, this evaluation often cannot be done reliably. Limited data suggest that coronary pressure-derived fractional flow reserve (FFR) supports decision making in equivocal left main disease.
All patients presenting to our institution between June 1999 and June 2004 with intermediate left main coronary artery disease (40%-80% diameter stenosis by angiography), or in whom left main coronary disease was suspected but could not be quantified angiographically, were included in this prospective single-center follow-up study. If FFR was <0.75 along the left main stem, surgical revascularization was recommended; if FFR was >0.80, medical treatment or percutaneous coronary intervention elsewhere in the coronary tree was chosen. If FFR was in the "gray zone," between > or = 0.75 and < or = 0.80 treatment recommendation was dependent on additional individual criteria. Primary end points were freedom from death, myocardial infarction, any coronary revascularization procedure, and stroke.
Fifty-one patients (mean age 62.2 +/- 9.6 years, 41 male) were included. In 27 patients (53%), coronary artery bypass surgery was performed. The remaining 24 patients (47%) were treated nonsurgically. Mean follow-up was 29 +/- 16 months. Estimated survival after 4 years of follow-up was 81% among patients in the surgical group and 100% among patients in the nonsurgical group. Event-free survival was 66% in the surgical group and 69% in the nonsurgical group.
Fractional flow reserve is helpful to identify patients with intermediate left main disease in whom deferral of surgical revascularization is associated with excellent survival and low event rates.
正确评估左主干病变的重要性对冠心病患者至关重要。仅基于临床和血管造影信息，这种评估往往无法可靠地完成。有限的数据表明，冠状动脉压力衍生的血流储备分数（FFR）有助于在模棱两可的左主干疾病中进行决策。
1999年6月至2004年6月期间，所有因左主干冠状动脉疾病处于中等程度（血管造影显示直径狭窄40%-80%）或疑似左主干冠状动脉疾病但血管造影无法量化的患者被纳入这项前瞻性单中心随访研究。如果沿左主干的FFR<0.75，则建议进行外科血运重建；如果FFR>0.80，则选择药物治疗或在冠状动脉树其他部位进行经皮冠状动脉介入治疗。如果FFR处于“灰色地带”，即≥0.75且≤0.80，则治疗建议取决于其他个体标准。主要终点是无死亡、心肌梗死、任何冠状动脉血运重建手术和中风。
纳入51例患者（平均年龄62.2±9.6岁，41例男性）。27例患者（53%）接受了冠状动脉搭桥手术。其余24例患者（47%）接受了非手术治疗。平均随访时间为29±16个月。随访4年后，手术组患者的估计生存率为81%，非手术组患者为100%。手术组的无事件生存率为66%，非手术组为69%。
血流储备分数有助于识别左主干疾病处于中等程度的患者，对于这些患者，推迟外科血运重建与良好的生存率和低事件发生率相关。
