Department of Cardiology, Catharina Hospital, Michelangelolaan 2, Eindhoven 5623 EJ, the Netherlands.
J Am Coll Cardiol. 2010 Jun 22;55(25):2816-21. doi: 10.1016/j.jacc.2009.11.096.
The purpose of this study was to investigate the relationship between angiographic and functional severity of coronary artery stenoses in the FAME (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation) study.
It can be difficult to determine on the coronary angiogram which lesions cause ischemia. Revascularization of coronary stenoses that induce ischemia improves a patient's functional status and outcome. For stenoses that do not induce ischemia, however, the benefit of revascularization is less clear.
In the FAME study, routine measurement of the fractional flow reserve (FFR) was compared with angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease. The use of the FFR in addition to angiography significantly reduced the rate of all major adverse cardiac events at 1 year. Of the 1,414 lesions (509 patients) in the FFR-guided arm of the FAME study, 1,329 were successfully assessed by the FFR and are included in this analysis.
Before FFR measurement, these lesions were categorized into 50% to 70% (47% of all lesions), 71% to 90% (39% of all lesions), and 91% to 99% (15% of all lesions) diameter stenosis by visual assessment. In the category 50% to 70% stenosis, 35% were functionally significant (FFR <or=0.80) and 65% were not (FFR >0.80). In the category 71% to 90% stenosis, 80% were functionally significant and 20% were not. In the category of subtotal stenoses, 96% were functionally significant. Of all 509 patients with angiographically defined multivessel disease, only 235 (46%) had functional multivessel disease (>or=2 coronary arteries with an FFR <or=0.80).
Angiography is inaccurate in assessing the functional significance of a coronary stenosis when compared with the FFR, not only in the 50% to 70% category but also in the 70% to 90% angiographic severity category.
本研究旨在探讨 FAME 研究中冠状动脉狭窄的血管造影和功能严重程度之间的关系。
在冠状动脉造影上确定哪些病变引起缺血可能较为困难。对引起缺血的冠状动脉狭窄进行血运重建可改善患者的功能状态和预后。然而，对于不引起缺血的狭窄，血运重建的益处则不太明确。
在 FAME 研究中，常规测量血流储备分数（FFR）并与血管造影进行比较，以指导多支血管病变患者的经皮冠状动脉介入治疗。FFR 的应用与血管造影相比，可显著降低 1 年时所有主要不良心脏事件的发生率。在 FAME 研究的 FFR 指导组的 1414 处病变（509 例患者）中，有 1329 处成功进行了 FFR 评估，纳入本分析。
在进行 FFR 测量之前，这些病变通过目测分为 50%至 70%（所有病变的 47%）、71%至 90%（所有病变的 39%）和 91%至 99%（所有病变的 15%）狭窄。在 50%至 70%狭窄病变中，35%存在功能意义（FFR≤0.80），65%无功能意义（FFR＞0.80）。在 71%至 90%狭窄病变中，80%存在功能意义，20%无功能意义。在次全狭窄病变中，96%存在功能意义。在所有 509 例经血管造影诊断为多支血管疾病的患者中，只有 235 例（46%）存在功能多支血管疾病（＞2 支冠状动脉 FFR≤0.80）。
与 FFR 相比，血管造影在评估冠状动脉狭窄的功能意义时不够准确，不仅在 50%至 70%狭窄病变中，在 70%至 90%狭窄病变的血管造影严重程度类别中也是如此。
