Iwasaki Kohichiro, Kusachi Shozo
Department of Cardiology, Okayama Central Hospital, Japan.
Curr Cardiol Rev. 2009 Nov;5(4):323-33. doi: 10.2174/157340309789317832.
The fractional flow reserve (FFR) is a simple, reliable, and reproducible physiologic index of lesion severity. In patients with intermediate stenosis, FFR≥0.75 can be used to safely defer percutaneous coronary intervention (PCI), and patients with FFR≥0.75 have a very low cardiac event rate. Coronary pressure measurement can determine which lesion should be treated with PCI in patients with tandem lesions, and PCI on the basis of FFR has been demonstrated to result in an acceptably low repeat PCI rate. FFR can identify patients with equivocal left main coronary artery disease who benefit from coronary bypass surgery. Coronary pressure measurement distinguishes patients with an abrupt pressure drop pattern from those with a gradual pressure drop pattern, and the former group of patients benefit from PCI. Coronary pressure measurement is clinically useful in evaluating sufficient recruitable coronary collateral blood flow for prevention of ischemia, which affects future cardiac events. FFR is useful for the prediction of restenosis after PCI. As an end-point of PCI, FFR ≥0.95 and ≥0.90 would be appropriate for coronary stenting and coronary angioplasty, respectively. In summary, if you encounter a coronary stenosis in doubt you should measure pressure rather than dilate it.
血流储备分数（FFR）是一种简单、可靠且可重复的病变严重程度的生理指标。在中度狭窄的患者中，FFR≥0.75可用于安全地推迟经皮冠状动脉介入治疗（PCI），且FFR≥0.75的患者心脏事件发生率非常低。冠状动脉压力测量可确定串联病变患者中哪些病变应接受PCI治疗，基于FFR的PCI已被证明可使重复PCI率低至可接受水平。FFR可识别出从冠状动脉搭桥手术中获益的左主干冠状动脉疾病诊断不明确的患者。冠状动脉压力测量可区分压力骤降型患者和压力渐降型患者，前一组患者从PCI中获益。冠状动脉压力测量在评估用于预防缺血的可充分募集的冠状动脉侧支血流方面具有临床应用价值，这会影响未来的心脏事件。FFR对预测PCI术后再狭窄很有用。作为PCI的终点，FFR≥0.95和≥0.90分别适用于冠状动脉支架置入术和冠状动脉成形术。总之，如果你遇到可疑的冠状动脉狭窄，你应该测量压力而不是进行扩张。
