| [Objective]Withing the development of social economy and the change of people’s lifestyle, the incidence and mortality of coronary heart disease showed a significant growth trend, and it has been a serious hazard to human health and life. The clinical "gold standard" to diagnosis of coronary heart disease is coronary angiography, it can make the coronary artery stenosis clear, including it’s location、degree、scope and so on, but it cannot know what the impact about distal blood flow which the coronary artery lesions have made, and we don’t know whether the lesion would lead to myocardial ischemia. As a new technology, fractional flow reserve (FFR) can make a functional assessment of the coronary lesion through the intracoronary pressure calculation of coronary blood flow; but this technology started late in our province, and the application of FFR technology is still in the exploratory stage in our hospital. So we make this study to explore the conducting ways and to make sure if this new technology could be used safely; and we use FFR value as a reference to guide the PCI treatment strategies, with further follow-up to evaluate it’s reference value.[Methods]1. the participants were patients admitted to the Cardiology Department of the First Affiliated Hospital of Kunming Medical University during October 2014 to March 2015. All of the patients were taken into account the diagnosis of coronary heart disease; and demonstrated with coronary borderline lesions through coronary angiography, and the reference vessel’s diameter is more than 2.5mm. With patients and their families agreed to use FFR and signed the informed consent.2. Participants’ basic data, including Demographic and clinical characteristics.3. The patients were randomly divided into FFR group and non FFR group. Using FFR to detect the target lesion with FFR group patients. According to anatomical characteristics of coronary artery disease、clinical symptoms、FFR value to decide, whether treat with PCI+ medication or pure medicine conservative treatment; To non FFR group patients, anatomical characteristics of coronary artery disease、clinical symptoms to decide the ways of treatment.4. Observe and record the success operation rate, complications and related symptoms in operation; followed up every patient after 1,3,6 months, evaluated their angina pectoris and CCS grade, record if there was myocardial infarction, revascularization and other major cardiovascular events happened.5. Using SPSS17.0 statistical software to dealing with all the observation data; compare the difference among the four groups of clinical baseline data of patients; record the measurement data of normal distribution with mean±standard deviation; using t (t’) test or variance analysis to compare between groups; count data and level data expressed as a percentage, and using chi square test or rank sum test to compare between groups;P<0.05,as there were significant statistically differences.[Results]1. a total of 23 patients participant in our study,10 patients in FFR group,13 patients in non FFR group; a total of 33 critical coronary lesions in 23 patients,16 lesions in FFR patients,17 lesions in non FFR patients; vascular stenosis rate (%): FFR group patients were 69.38 ±8.14,non FFR group were 66.18±11.25; two groups of patients with clinical features (age, body mass index, diabetes, hypertension, high Blood lipid, cardiac ejection fraction), there were no significant difference.2.9 patients in FF group appeared with chest tightness, palpitation during the process of intravenous infusion of ATP,8 patients were tolerable with that, and these symptoms continued to the end of administration; two of them had facial flushing, and all of the symptoms continued to the end of administration; one of them had facial flushing, and couldn’t tolerate with these,so we stopped infusion ATP, these symptoms lasted 7～8 min after we stopped infusion ATP;1 patient was induced with rapid atrial fibrillation during the process of administration, and it recovered to sinus rhythm after 5 minutes of stopping infusion ATP;1 patient was induced with two degree atrioventricular block, but the patient could tolerate with that, and symptoms disappeared when the infusion stopped.1 patient has not any adverse reaction. All patients of this group were not involved in intervention related complications.3. Follow up after operation, the average follow-up time was 5.33±0.74 months: The patients who were treated with PCI in non FFR group, the angina CCS grade was 2～3 grade preoperative,5 patients have no symptoms of angina pectoris postoperative, 1 patient still had angina symptom, but the degree reduced significantly, the CCS grade from preoperative 3 to postoperative recovery level of grade 1; The patients who were treated with medicine conservative treatment of patients in non FFR group were atypical angina pectoris or CCS grade 1, give them two grade prevention medicine standard treatment after operation,4 patients have no angina pectoris symptoms,3 patients were still attacked with angina pectoris, and have no significant improvement compared with preoperative. in FFR group,4 patients were treated with PCI+ medicine, and they were CCS grade 2～4 preoperative, two of them have no symptoms of angina pectoris postoperative,2 cases recovered to CCS grade 1; 6 patients were treated with drug conservative treatment in this group, they were atypical angina or CCS grade 1 preoperative, give them two grade prevention medicine standard treatment after operation,2 patients were still attacked with angina pectoris, and increased to CCS Level 2; 1 patients remained CCS level 1; 3 cases of them have no angina pectoris postoperative.. During the follow-up period, two group patients were not attacked with major adverse cardiovascular events.[Conclusion]1. FFR detection technology is easy to operate and safe, and the keys of operation were zero and equalize.2. Patients aways appeared with palpitations, chest tightness, flushing during intravenous infusion of ATP rapidly, some patients also happen with arrhythmia; and must be cautious to use with cardiac or pulmonary insufficiency patients, or avoid to using it with these patients.3. FFR detection has certain guiding significance in coronary artery intervention therapy, but its effectiveness is worth to further discussion for patients in Yunnan Plateau. |
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