Elfaramawy Amr, Hassan Mohamed, Nagy Michael, ElGuindy Ahmed, Elmahdy Mahmoud F
Cardiology Department, Cairo University, Cairo, Egypt.
Cardiology Department, Aswan Heart Center, Aswan, Egypt.
Egypt Heart J. 2018 Sep;70(3):161-165. doi: 10.1016/j.ehj.2017.12.007. Epub 2017 Dec 27.
Fractional flow reserve (FFR) is the reference standard for the assessment of the functional significance of coronary artery stenoses, but remains underutilized. Our aims were to study whether FFR changed the decision for treatment of intermediate coronary lesions and to assess the clinical outcome in the deferred and intervention groups.
In this retrospective study, coronary angiograms of patients with moderately stenotic lesions (40-70%) for which FFR was performed were re-analyzed by three experienced interventional cardiologists (blinded to FFR results) to determine its angiographic significance and whether to defer or perform an intervention.
We revised 156 equivocal lesions of 151 patients. The clinical presentation were stable angina (65.6%) and acute coronary syndrome in (34.4%). All reviewers had concordant agreement to do PCI in 59 (37.8%) lesions based on angiographic assessment. Interestingly 23 (39%) of these lesions were functionally non-significant by FFR. The reviewers agreed to defer 97 (62.2%) lesions, however, 32 (33%) of these lesions were functionally significant by FFR and necessitated PCI. MACE were similar in both groups (1.5% vs 2.4%, p = 1.0).
Mismatches between visually- and FFR- estimated significance of intermediate coronary stenosis are frequently encountered across a wide spectrum of clinical presentations. FFR leads to a change in decision for coronary intervention. The clinical and cost implications of such changes-in areas with limited resources- needs further evaluation.
血流储备分数（FFR）是评估冠状动脉狭窄功能意义的参考标准，但仍未得到充分利用。我们的目的是研究FFR是否会改变对中度冠状动脉病变的治疗决策，并评估延期治疗组和干预组的临床结局。
在这项回顾性研究中，由三位经验丰富的介入心脏病专家（对FFR结果不知情）对进行了FFR的中度狭窄病变（40%-70%）患者的冠状动脉造影进行重新分析，以确定其血管造影意义以及是否延期或进行干预。
我们对151例患者的156处模棱两可的病变进行了重新评估。临床表现为稳定型心绞痛（65.6%）和急性冠状动脉综合征（34.4%）。所有评估者基于血管造影评估对59处（37.8%）病变一致同意进行经皮冠状动脉介入治疗（PCI）。有趣的是，这些病变中有23处（39%）经FFR评估为功能无意义。评估者同意延期97处（62.2%）病变，然而，这些病变中有32处（33%）经FFR评估为功能有意义，需要进行PCI。两组主要不良心血管事件（MACE）相似（1.5%对2.4%，p = 1.0）。
在广泛的临床表型中，经常会遇到视觉评估和FFR评估的中度冠状动脉狭窄意义不匹配的情况。FFR会导致冠状动脉干预决策的改变。在资源有限的地区，这种改变对临床和成本的影响需要进一步评估。
