Lindstaedt M, Mügge A
Medizinische Klinik II-Kardiologie und Angiologie, BG Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, Bochum,Germany.
Herz. 2011 Aug;36(5):410-6. doi: 10.1007/s00059-011-3486-8.
Revascularization of coronary artery lesions should be based on objective evidence of ischemia, as recommended by the guidelines of the European Society of Cardiology. However, even in the case of stable coronary artery disease and elective percutaneous coronary intervention (PCI), pre-procedural noninvasive stress test results are available in a minority of patients only. It is common practice for physicians to make decisions on revascularization in the catheterization laboratory after a cursory review of the angiogram, despite the well-recognized inaccuracy of such an approach. Myocardial fractional flow reserve (FFR) measured by a coronary pressure wire is a specific index of the functional significance of a coronary lesion, with superior diagnostic accuracy for the detection of ischemia than any noninvasive stress test. FFR trials on patients with single and multivessel disease, such as the DEFER and FAME studies, have demonstrated that the clinical benefit of PCI with respect to patient outcome is greatest when revascularization is limited to lesions inducing ischemia, whereas lesions not inducing ischemia should be treated medically.
冠状动脉病变的血运重建应基于缺血的客观证据，这是欧洲心脏病学会指南所推荐的。然而，即使在稳定型冠状动脉疾病和择期经皮冠状动脉介入治疗（PCI）的情况下，术前无创负荷试验结果仅在少数患者中可用。尽管这种方法的准确性已得到公认，但医生通常在导管室对血管造影进行粗略检查后就做出血运重建的决定。通过冠状动脉压力导丝测量的心肌血流储备分数（FFR）是冠状动脉病变功能意义的一个特定指标，其检测缺血的诊断准确性优于任何无创负荷试验。针对单支和多支血管病变患者的FFR试验，如DEFER和FAME研究，已经证明，当血运重建仅限于诱发缺血的病变时，PCI对患者预后的临床益处最大，而不诱发缺血的病变应进行药物治疗。
