The Long-term Prognostic Analysis Of Coronary Borderline Lesion Guided By Fractional Flow Reserve

Objective:To discuss the long-term prognostic value of coronary borderline lesion guided by fractional flow reserve(FFR),evaluate the value of FFR measurement in diabetic patients with coronary borderline lesion and the effect of single vessel lesion length on the outcomes of patients,provide clinical evidence for evaluation and treatment strategy of coronary borderline lesion.Methods:Patients with coronary borderline lesions diagnosed by coronary angiography(CAG)in TEDA international cardiovascular hospital between May 2012 and December 2016 were enrolled and stratified according to diabetes mellitus status and single vessel lesion length.Their treatment plans were based on FFR.Patients with FFR<0.75 underwent percutaneous coronary intervention(PCI).Patients with FFR>0.80 were given medical therapies.If FFR was 0.75 to 0.80,the treatment plans were based on the clinical situation and importance of the myocardium for which diseased coronary artery supply blood.FFR value,proportion of patients who underwent PCI and incidence of major adverse cardiovascular event(MACE)during the follow-up period were compared and the reasons for MACE were analysed systematically.Results:1 In this study,292 patients with 353 coronary borderline lesions were enrolled.According to the results of FFR,82 patients(28.1%)were performed PCI,210 patients were treated with drugs.280 patients were followed up.PCI group(78 patients)had no MACE.In drugs group,13 patients who occurred target vascular revascularization,3 patients who occurred cardic death(1 patient may be related to FFR vessel,1 patient was irrelated,1 patient was uncertain),1 patient who occurred non-fatal myocardial infarction(caused by coronary spasm,which was not related to FFR vessel).2 Patients were divided into groups according to diabetes mellitus status:73 patients with diabetes had 87 lesions,FFR value was 0.83±0.09,20 patients(27.4%)underwent PCI,53 patients(72.6%)was treated with drugs,patients performed PCI had no MACE,6 patients given drugs occurred MACE,including cardiac death 1 patient(which was irrelated to FFR vessel),target vascular revascularization 5 patients caused by progression of lesions;there were 219 non-diabetic patients,FFR value was 0.84±0.08,62 patients(28.3%)underwent PCI,157 patients(71.7%)were given drugs.Patients who underwent PCI had no MACE,11 patients given drugs occurred MACE,including cardiac death 2 patients(1 patient may be related to FFR vessel,1 patient was uncertain),nonfatal myocardial infarction 1 patient(caused by coronary spasm,which was irrelated to FFR vessel),target vascular revascularization 8 patients caused by progression of lesions.There was no significant difference in FFR value,rations of patients who received PCI and incidence of MACE between the two groups(P>0.05).3 Patients with single vessel lesion were divided into groups according to lesion length:a total of 224 patients with single coronary artery borderline lesion were enrolled,including 56 patients with long lesion(>20mm),FFR value was 0.78±0.09,24 patients(42.9%)underwent PCI,32 patients(57.1%)were treated with drugs;168 patients with short lesion(?20mm),FFR value was 0.85±0.07,26 patients(15.5%)underwent PCI,142 patients(84.5%)were given drugs.215 patients were followed up(long lesion 161 patients,short lesion 54 patients).15 patients occurred MACE,including 10 patients with short lesion(6.2%,target vascular revascularization 9 patients,cardiac death 1 patient)and 5 patients with long lesion(9.3%,target vascular revascularization 2 patients,cardiac death 2 patients and non-fatal myocardial infarction 1 patient).FFR value of patients with long lesion was significantly lower than patients with short lesion,the percentage of patients with long lesion performed PCI was significantly higher than patients with short lesion.The significant difference of MACE was not observed in different lesion length(P>0.05).Conclusion:1 FFR can accurately determine whether the coronary borderline lesion is ischemic,PCI guided by FFR can reduce unnecessary stent implantation and improve prognosis of patients.2 Diabetes cannot affect the treatment and long-term prognosis of patients with borderline lesion guided by FFR,and FFR measurement applied in diabetic patients is reliable.3 The length of lesion in single vessel patients determines the result of FFR examination,patients with long lesion had lower FFR and higher ratio of PCI,but the length of lesion cannot affect the outcomes.