Department of Medicine 2 - Cardiology and Angiology, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany; Department of Medicine I, St.-Johannes Hospital, Dortmund, Germany; Heart and Diabetes Center North Rhine-Westphalia, Department of Cardiology, Bad Oeynhausen, Germany; Department of Medicine I, Ludwig Maximilians University Munich, and Cardiology Practice, Munich, Germany; Department of Cardiology, Pulmonology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, Germany.
Dtsch Arztebl Int. 2019 Mar 22;116(12):205-211. doi: 10.3238/arztebl.2019.0205.
Approximately 800 000 coronary angiography procedures are per- formed in Germany each year, mainly in order to identify coronary artery stenoses. As a rule, revascularization is indicated only when coronary artery stenoses cause relevant ischemia, but this cannot be determined unequivocally by angiography alone. Pressure wire measurement and the measurement of fractional flow reserve (FFR) enable direct evaluation of the hemodynamic relevance of coronary artery stenoses during diagnostic coronary angiography.
This review is based on publications retrieved by a selective search in PubMed focusing especially on large randomized trials, registry studies, and meta- analyses on either pressure wire measurement or FFR.
According to a registry study from France, the hemodynamic evaluation of a stenosis during coronary angiography affected decisions about revascularization in 43% of cases. Randomized multicenter trials have shown that a combined end- point consisting of death, myocardial infarction, or revascularization arose signifi- cantly less commonly in the FFR group than in the group receiving angiography without FFR (13.2% versus 18.3%; p = 0.02), and that patients with one or more hemodynamically significant coronary artery stenoses (FFR ≤ 0.80) benefited more from revascularization than from medical management alone (event rate, 8.1% versus 19.5%; p <0.001). It was also shown that revascularization yields no benefit if relevant ischemia has been ruled out, even if the angiogram shows high-grade coronary artery stenoses.
All cardiac catheter laboratories should be capable of performing pres- sure wire measurements and measurements of FFR and should do so regularly if ischemia due to coronary artery stenosis cannot be demonstrated non-invasively. A pathological FFR measurement is an indication for revascularization.
德国每年大约进行 80 万次冠状动脉造影术，主要用于识别冠状动脉狭窄。通常情况下，只有当冠状动脉狭窄导致相关缺血时才需要进行血运重建，但仅凭血管造影无法明确确定。压力导丝测量和血流储备分数（FFR）的测量可在诊断性冠状动脉造影期间直接评估冠状动脉狭窄的血流动力学相关性。
本综述基于通过选择性搜索 PubMed 检索到的出版物，重点关注大型随机试验、注册研究以及关于压力导丝测量或 FFR 的荟萃分析。
根据来自法国的一项注册研究，在冠状动脉造影期间对狭窄的血流动力学评估影响了 43%的血运重建决策。随机多中心试验表明，包含死亡、心肌梗死或血运重建的复合终点在 FFR 组中比在未进行 FFR 的血管造影组中发生率显著降低（13.2%比 18.3%；p = 0.02），并且存在一个或多个血流动力学显著狭窄（FFR ≤ 0.80）的患者从血运重建中获益大于单纯药物治疗（事件发生率，8.1%比 19.5%；p <0.001）。还表明，如果已经排除了相关缺血，即使血管造影显示高度狭窄的冠状动脉，血运重建也没有益处。
如果不能通过无创方法证明存在因冠状动脉狭窄引起的缺血，所有心脏导管实验室都应该能够进行压力导丝测量和 FFR 测量，并且应该定期进行这些测量。病理性 FFR 测量是血运重建的指征。
