The Value Of Interventional Treatment For Coronary Intermediate Lesions Guided By FFR Combined With IVUS

Objective: It did not need interventional treatment when fractional flow reserve(FFR)was more than 0.80 and some studies suggested that FFR<0.75 was an indication for coronary revascularization.But 0.75≤FFR<0.80 is a “hot seat” for cardiologist,it still have controversy for whether or not to do revascularization.We enrolled 59 patients with single coronary borderline lesion which was detected by coronary angiography and the FFR value was ≥ 0.75 and < 0.80.All patients were administrated with standard drug treatment for coronary heart disease(CHD).Based on the intention of patients,they were administrated with revascularization or drug treatment(the patients with unstable lesions and without revascularization treatment were given with intensified statin therapy for 1 month).By follow-up of 12 months,calculate the incidence of major adverse cardiac events(MACE),thus to evaluate the difference of prognosis for different treatment strategies.Methods: This study was approved by ethics committee of hospital.In this study we selected the patients who suffered with coronary borderline lesions(rate of the lumen stenosis is 50-70% showed by Coronary angiography)and FFR value was ≥0.75 and <0.80,thus 59 patients were enrolled in our center from June 2011 to January 2014,and they were examined with IVUS detecting,and based on their own intension and results of IVUS examination,they were divided into three groups:(1)Revascularization group(n=17): treated by percutaneous coronary intervention(PCI)and standard drug administration;(2)Intensified Statin group(n=22);(3)Standard drug group(n=20).The incidence rate of MACE in all patients were analyzed at 1 month,3 months,6 months and 12 months(including: cardiac death,recurrence of angina pectoris,acute myocardial infarction,repeat revascularization treatment).Results:(1)Three groups were completed follow-up on schedule,no patient was lose during follow-up,and there was no statistical difference of clinical basic characteristics among the three groups of patients;(2)No MACE occurred during the 1 month and 3 months follow-up;(3)MACE in 6 months follow-up:One patient occurred postoperative recurrence of angina pectoris in Revascularization group;one patient occurred acute myocardial infarction in Intensified statin group,no MACE occurred in Standard drug group.There is no statistically significant difference of the incidence of MACE among these three groups(P > 0.05);(4)MACE in 12 months follow-up : Two patients occurred postoperative recurrence of angina pectoris in Revascularization group;one patient occurred acute myocardial infarction in intensified statin group,two patients occurred recurrence of angina pectoris in occurred in Standard drug group.There is no statistically significant difference of the incidence of MACE among these three groups(P > 0.05).Conclusion:(1)Regardless being treated by revascularization and non-revascularization,there is no variation in MACE incidence rate of patients with single borderline coronary lesion and 0.75≤FFR<0.80.(2)IVUS examination could provide guidance to decide whether intensified statin therapy was needed for those patients with coronary borderline lesions and 0.75 ≤FFR <0.80.