Cardiovascular Research Center Aalst, OLV Clinic, Moorselbaan n 164, B 9300 Aalst, Belgium.
Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
Eur Heart J. 2017 Jul 1;38(25):1959-1968. doi: 10.1093/eurheartj/ehw505.
The aim of this review is to highlight the role of invasive functional evaluation in patients in whom coronary artery bypass graft (CABG) is indicated, and to examine the clinical evidence available in favour of fractional flow reserve (FFR) adoption in these patients, outline appropriate use, as well as point out potential pitfalls. FFR after CABG will also be reviewed, highlighting its correct interpretation and adoption when applied to both native coronary arteries and bypass grafts. Practice European guidelines support the use of FFR to complement coronary angiography with the highest degree of recommendation (Class IA) for the assessment of coronary stenosis before undertaking myocardial revascularization when previous non-invasive functional evaluation is unavailable or not conclusive. As a result, FFR has been adopted in routine clinical practice to guide clinicians decision as to whether or not perform a revascularization. Of note, due to the increasing confidence of the interventional cardiologists, FFR guidance is also being implemented to indicate or guide CABG. This is in anticipation of supportive clear-cut evidence, since recommendations for FFR adoption were based on randomized clinical trials investigating percutaneous coronary intervention (PCI) strategies in which patients with typical indications for CABG were excluded (e.g. left main disease, valvular disease, and coronary anatomy unsuitable for PCI). Based on the critical appraisal of the literature, FFR can play an important role in risk stratification and determining management strategy of patients either before or after CABG.
这篇综述的目的是强调在需要进行冠状动脉旁路移植术（CABG）的患者中进行有创功能评估的作用，并探讨支持在这些患者中采用血流储备分数（FFR）的临床证据，概述其合理应用，并指出潜在的陷阱。还将回顾 CABG 后的 FFR，强调其在应用于原生冠状动脉和旁路移植时的正确解释和采用。实践欧洲指南支持使用 FFR 来补充冠状动脉造影，在进行心肌血运重建时，对于无法进行或结果不确定的先前非侵入性功能评估，其推荐程度最高（IA 类）。因此，FFR 已在常规临床实践中采用，以指导临床医生决定是否进行血运重建。值得注意的是，由于介入心脏病学家的信心不断增强，FFR 指导也被用于指示或指导 CABG。这是因为在推荐采用 FFR 时，基于的是研究经皮冠状动脉介入治疗（PCI）策略的随机临床试验，这些研究排除了具有典型 CABG 适应证的患者（例如，左主干疾病、瓣膜疾病和不适合 PCI 的冠状动脉解剖结构）。基于对文献的批判性评价，FFR 可以在 CABG 前后对患者的风险分层和确定管理策略方面发挥重要作用。
