Costa Marco A, Sabate Manel, Staico Rodolfo, Alfonso Fernando, Seixas Ana C, Albertal Mariano, Crossman Arthur, Angiolillo Dominick J, Zenni Martin, Sousa J Eduardo, Macaya Carlos, Bass Theodore A
University of Florida, Shands Jacksonville, Cardiovascular Center, Jacksonville, FL 32209, USA.
Am Heart J. 2007 Feb;153(2):296.e1-7. doi: 10.1016/j.ahj.2006.10.036.
Patients with small coronary arteries are at high risk for complications after percutaneous coronary intervention (PCI). The objective of our study was to investigate the correlation between angiography, intravascular ultrasound (IVUS), and fractional flow reserve (FFR) in patients with moderate stenoses in small (<2.8 mm) coronary arteries.
Sixty consecutive patients, of 800 scheduled for PCI during the study period, were prospectively enrolled in the study. The FFR was measured after a 2-minute infusion of adenosine. For the preprocedural assessments, 60 patients underwent an FFR measurement, 56 underwent an IVUS, and 60 underwent an angiography; for the postprocedural assessments, 22 patients underwent an FFR measurement, 18 underwent an IVUS, and 22 underwent an angiography. The jeopardy score for the target vessel was calculated. Data were analyzed by an independent core laboratory. Patients with an FFR >0.75 were deferred from PCI. Patients were stratified in 2 groups according to their FFR values (< or =0.75 vs >0.75) and were followed for 1 year. Significant (FFR < or =0.75) coronary stenosis was observed in only 35% of the patients. The mean preprocedural FFR values were 0.79 +/- 0.13 for the overall population, 0.64 +/- 0.08 for the patients with an FFR < or =0.75, and 0.87 +/- 0.06 for the patients with an FFR >0.75. There was no correlation between angiography, IVUS, and FFR. The jeopardy score was inversely correlated with FFR (R = -0.32). Only a third of the patients with optimal stenting defined by IVUS achieved an FFR >0.90. After 1 year, 24% of the patients with an FFR < or =0.75 required a repeat PCI. There was no occurrence of myocardial infarction or death, and only 2.6% of the patients deferred from PCI required revascularization.
Anatomical parameters are limited in determining the hemodynamic significance of small coronary disease. Most moderate stenoses in small coronaries could be safely deferred from PCI based on FFR.
小冠状动脉患者在经皮冠状动脉介入治疗（PCI）后发生并发症的风险较高。我们研究的目的是调查小（<2.8mm）冠状动脉中度狭窄患者血管造影、血管内超声（IVUS）和血流储备分数（FFR）之间的相关性。
在研究期间计划进行PCI的800例患者中，连续60例患者被前瞻性纳入研究。在输注腺苷2分钟后测量FFR。对于术前评估，60例患者进行了FFR测量，56例进行了IVUS检查，60例进行了血管造影；对于术后评估，22例患者进行了FFR测量，18例进行了IVUS检查，22例进行了血管造影。计算靶血管的危险评分。数据由独立的核心实验室进行分析。FFR>0.75的患者延期进行PCI。根据FFR值（≤0.75与>0.75）将患者分为两组，并随访1年。仅35%的患者观察到显著（FFR≤0.75）冠状动脉狭窄。总体人群术前FFR平均值为0.79±0.13，FFR≤0.75的患者为0.64±0.08，FFR>0.75的患者为0.87±0.06。血管造影、IVUS和FFR之间无相关性。危险评分与FFR呈负相关（R=-0.32）。根据IVUS定义的最佳支架置入患者中，只有三分之一的患者FFR>0.90。1年后，FFR≤0.75的患者中有24%需要再次进行PCI。未发生心肌梗死或死亡，延期进行PCI的患者中只有2.6%需要血运重建。
解剖学参数在确定小冠状动脉疾病的血流动力学意义方面存在局限性。基于FFR，大多数小冠状动脉中度狭窄可安全延期进行PCI。
