Lavi Shahar, Rihal Charanjit S, Yang Eric H, Fassa Amir-Ali, Elesber Ahmad, Lennon Ryan J, Mathew Verghese, David Holmes R, Lerman Amir
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Catheter Cardiovasc Interv. 2007 Oct 1;70(4):525-31. doi: 10.1002/ccd.21154.
To assess the role of fractional flow reserve (FFR) in guiding therapy in the drug eluting stent (DES) era.
FFR is a useful index for evaluation of the physiological significance of angiographically indeterminate coronary artery lesions. However, its role in the DES era is unknown.
Long term outcome of 281 patients with angiographically indeterminate coronary lesions and borderline FFR (0.75 </= FFR < 0.9) was obtained. The outcome of patients who had a DES placed (n = 58), was compared with that of consecutive patients with borderline FFR that were treated by PCI with bare metal stents (BMS, n = 58), or were deferred from revascularization (n = 165).
FFR was significantly higher in the deferred group (median and IQR); 0.85 (0.82 to 0.88) compared with the BMS (0.78; 0.76 to 0.82) and the DES (0.79; 0.77 to 0.82), P < 0.001. Pretreatment FFR was a significant determinant of long term event rates in the deferred patients (P = 0.002) but had no effect in patients treated by PCI. In the deferred group, there were fewer events (death, myocardial infarction, target vessel revascularization) compared with the BMS group; but no significant difference was observed between the DES and the deferred groups.
In borderline FFR, long term outcome after PCI with BMS is inferior to conservative therapy or PCI with DES. While conservative management is preferable in these patients, PCI with DES may be considered in specific circumstances.
评估血流储备分数（FFR）在药物洗脱支架（DES）时代指导治疗中的作用。
FFR是评估血管造影不确定的冠状动脉病变生理意义的有用指标。然而，其在DES时代的作用尚不清楚。
获取了281例血管造影不确定的冠状动脉病变且FFR处于临界值（0.75≤FFR＜0.9）患者的长期预后。将植入DES的患者（n = 58）的预后与连续的FFR处于临界值且接受裸金属支架（BMS）PCI治疗的患者（n = 58）或延期血运重建的患者（n = 165）的预后进行比较。
延期血运重建组的FFR显著更高（中位数和四分位间距）；为0.85（0.82至0.88），而BMS组为0.78（0.76至0.82），DES组为0.79（0.77至0.82），P＜0.001。治疗前FFR是延期血运重建患者长期事件发生率的重要决定因素（P = 0.002），但对接受PCI治疗的患者没有影响。在延期血运重建组中，与BMS组相比事件（死亡、心肌梗死、靶血管血运重建）更少；但DES组与延期血运重建组之间未观察到显著差异。
在FFR临界值的情况下，BMS PCI后的长期预后不如保守治疗或DES PCI。虽然这些患者首选保守治疗，但在特定情况下可考虑DES PCI。
