University of California, Irvine, USA.
Veterans Administration Long Beach Health Care System, Long Beach, USA.
Curr Cardiol Rep. 2022 May;24(5):541-550. doi: 10.1007/s11886-022-01675-8. Epub 2022 Mar 2.
Multivessel coronary artery disease, defined as significant stenosis in two or more major coronary arteries, is associated with high morbidity and mortality. The diagnosis and treatment of multivessel disease have evolved in the PCI era from solely a visual estimation of ischemic risk to a functional evaluation during angiography. This review summarizes the evidence and discusses the commonly used methods of multivessel coronary artery stenosis physiologic assessment.
While FFR remains the gold standard in coronary physiologic assessment, several pressure-wire-based non-hyperemic indices of functional stenosis have been developed and validated as well as wire-free angiographically derived quantitative flow ratio. Identifying and treating functionally significant coronary atherosclerotic lesions reduce symptoms and major adverse cardiovascular events. Coronary physiologic assessment in multivessel disease minimizes the observer bias in visual estimates of stenosis, changes clinical management, and improves patient outcomes.
多支冠状动脉疾病定义为两支或以上主要冠状动脉存在显著狭窄，与高发病率和死亡率相关。在经皮冠状动脉介入治疗（PCI）时代，多支血管疾病的诊断和治疗已从单纯基于缺血风险的影像学评估发展为血管造影时的功能评估。本综述总结了相关证据，并讨论了多支冠状动脉狭窄的常用生理学评估方法。
尽管血流储备分数（FFR）仍然是冠状动脉生理学评估的金标准，但也已经开发和验证了几种基于压力导丝的非充血性功能狭窄指数，以及无导丝的基于血管造影的定量血流比。明确并治疗功能上有意义的冠状动脉粥样硬化病变可减轻症状和主要不良心血管事件。多支血管疾病中的冠状动脉生理学评估可减少对狭窄的影像学评估中的观察者偏倚，改变临床管理，并改善患者结局。
