Elgendy Islam Y, Choi Calvin, Bavry Anthony A
Department of Medicine, University of Florida, Gainesville, FL, USA.
North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.
Cardiol Ther. 2015 Dec;4(2):191-6. doi: 10.1007/s40119-015-0051-1. Epub 2015 Sep 30.
Fractional flow reserve (FFR) is recommended by society guidelines for assessment of the hemodynamic significance of intermediate coronary lesions when non-invasive evidence of myocardial ischemia is unavailable. However, the prevalence of FFR usage in current practice and how FFR values impact revascularization decisions are not well known.
At a single-center Veterans Administration Hospital, all subjects referred for coronary angiography for any indication from the period from May 2012 until January 2014 were prospectively entered into a database. FFR was measured in all intermediate coronary lesions (30-70% stenosis). Based on the FFR results, the lesions were categorized into 3 different groups: FFR > 0.80 (non-ischemic), FFR 0.75-0.80 (gray zone), and FFR < 0.75 (ischemic).
A total of 1482 cardiac catheterizations were performed during the study period. FFR was performed in 347 (23%) of these procedures. The total numbers of intermediate coronary lesions evaluated with FFR were 429. The mean FFR value was 0.79 (median = 0.80; interquartile range 0.64-0.96). Among 211 non-ischemic lesions, revascularization was deferred in 201 (95%). In the gray-zone group (73 lesions), 35 (48%) lesions were treated with percutaneous coronary intervention (PCI), 11 (15%) lesions were referred for coronary artery bypass grafting surgery (CABG), and 27 (37%) lesions were treated medically. In the ischemic group (145 lesions), 82 (57%) lesions were treated with PCI, 41 (28%) lesions were referred for CABG, and 22 (15%) lesions were treated medically.
At a Veterans Administration Hospital, FFR was performed in approximately one out of four total catheterizations. FFR documented lack of ischemia in about half of the intermediate coronary lesions, and thus reduced the need for many revascularization procedures.
当缺乏心肌缺血的非侵入性证据时，社会指南推荐使用血流储备分数（FFR）来评估冠状动脉中度病变的血流动力学意义。然而，目前临床实践中FFR的使用情况以及FFR值如何影响血运重建决策尚不清楚。
在一家单中心退伍军人管理局医院，2012年5月至2014年1月期间因任何适应症接受冠状动脉造影的所有受试者均被前瞻性地纳入数据库。对所有冠状动脉中度病变（狭窄30%-70%）进行FFR测量。根据FFR结果，将病变分为3个不同组：FFR>0.80（非缺血性）、FFR 0.75-0.80（灰色地带）和FFR<0.75（缺血性）。
研究期间共进行了1482次心导管检查。其中347次（23%）检查进行了FFR测量。使用FFR评估的冠状动脉中度病变总数为429个。FFR平均值为0.79（中位数=0.80；四分位间距0.64-0.96）。在211个非缺血性病变中，201个（95%）延迟了血运重建。在灰色地带组（73个病变）中，35个（48%）病变接受了经皮冠状动脉介入治疗（PCI），11个（15%）病变被转诊进行冠状动脉旁路移植术（CABG），27个（37%）病变接受药物治疗。在缺血组（145个病变）中，82个（57%）病变接受了PCI，41个（28%）病变被转诊进行CABG，22个（15%）病变接受药物治疗。
在一家退伍军人管理局医院，约四分之一的导管检查进行了FFR测量。FFR表明约一半的冠状动脉中度病变不存在缺血，从而减少了许多血运重建手术的必要性。
