冠状动脉血流比冠状动脉解剖结构更重要吗？
Does coronary flow trump coronary anatomy?
作者信息
Gould K Lance
机构信息
Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School at Houston, Memorial Hermann Hospital, Houston, Texas 77030, USA.
出版信息
JACC Cardiovasc Imaging. 2009 Aug;2(8):1009-23. doi: 10.1016/j.jcmg.2009.06.004.
Coronary function versus anatomy, flow versus stenosis: which optimizes coronary artery disease (CAD) management? In patients, coronary flow is poorly related to stenosis severity, and revascularization fails to improve mortality over medical treatment in randomized trials. Yet percutaneous intervention (PCI) guided by fractional flow reserve reduces coronary events more than PCI guided by arteriographic stenosis. These paradoxes are explained by the poor relation between coronary flow reserve (CFR) and stenosis severity due to diffuse CAD, with surprising clinical implications. Should the concept of anatomically "critical" coronary stenosis be replaced by the concept of "critical" CFR reduction for managing CAD?
冠状动脉功能与解剖结构、血流与狭窄：哪种方式能优化冠状动脉疾病（CAD）的管理？在患者中，冠状动脉血流与狭窄严重程度的相关性较差，并且在随机试验中，血管重建术在降低死亡率方面并不优于药物治疗。然而，与基于血管造影狭窄进行的经皮冠状动脉介入治疗（PCI）相比，基于血流储备分数引导的PCI能更多地减少冠状动脉事件。这些矛盾现象可通过弥漫性CAD导致的冠状动脉血流储备（CFR）与狭窄严重程度之间的不良关系来解释，这具有令人惊讶的临床意义。在CAD管理中，解剖学上“临界”冠状动脉狭窄的概念是否应由“临界”CFR降低的概念所取代？
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