| Objective: The purpose of this study was to evaluate the coronarypressure-derived fractional flow reserve (FFR) guided percutaneous coronaryintervention (PCI) of borderline lesion by recording the incidence of majoradverse cardiac events (MACE) during12months follow-up.Methods: From April2011to December2011，a total of71in-hospitalpatients with angina admitted to our department with single angiographicallyintermediate de novo stenosis in a native coronary artery were enrolled intothe present Study. Patients were eligible if they fulfilled the followinginclusion criteria: single angiographically intermediate de novo stenosis(diameter stenosis by visual assessment was50％-70％) in a native coronaryartery with a reference diameter of more than2.5mm. Patients with a totalocclusion of the target artery, acute Q-wave infarction, or unstable anginadocumented by transient ST-segment abnormality were excluded. Patientswith severe hepatic, renal insufficiency and malignancy were excluded.Patients with contrast agent allergy, aspirin, clopidogrel and heparin resistance,contraindications of the coronary artery angiography (CAG) and PCI wereexcluded. Patients with small-sized target arteries (reference diameter＜2.5mm) were excluded because these patients have less benefit from PCI andtheir inclusion could bias the outcome. stenosis． All Angiograms wereanalyzed with quantitative coronary analysis （QCA） by2experiencedcardiologists. Using the guiding catheter as a scaling device, referencediameter, minimal lumen diameter, and percent diameter stenosis werecalculated as the mean of the both values obtained from2cardiologists.Immediately after coronary angiography, FFR was measured using a0.014-inch sensor-tipped guidewire system. The wire was introduced through a6-F guiding catheter, advanced into the coronary artery, and Adenosine wasadministered intracoronary to induce maximum hyperemia. Fractional flowreserve was calculated as the ratio of mean hyperemic distal coronary pressure(Pd) measured by the pressure wire to mean aortic pressure (Pa) measured bythe guiding catheter. The measurement was performed twice, and FFR wastaken as the mean of both measurements. All patients divided into3groups:1)patients with an FFR≥0.75in whom Conservative medical therapy wasgiven(A group, n=30，20men，10Women, mean age63.07±9.25years);2)patients with an FFR＜0.75in whom PCI was performed(B group, n=20，13men，7Women, mean age59.90±9.01years); and3) patients with an FFR＜0.75in whom PCI was deferred and given Conservative medical therapy(Cgroup n=21，15men，6Women, mean age59.81±8.33years). All enrolledpatients received300mg/d aspirin at least three days before PCI, thencontinue used300mg/d for one month after PCI and the life-long dosage was100mg/d. Clopidogrel Were used75mg/d before three days before and postPCI at least12months．Heparin is administered using a weight adjusted doseand is monitored using activated coagulation time (ACT). In general an ACTvalue of at least250s is desirable. Subcutaneous injection of low molecularweight heparin at least10days post PCI. The clinical information includingage，gender, risk factors(Diabetes，Hypertension, Hyperlipidemia, Currentsmoker, Family history of CAD), heart function(left ventricle ejection fraction.LVEF)，distribution of lesions，diameter stenosi（sDS）were collected. Clinicalfollow-up were performed at hospital discharge and12months after PCI,every patients of three groups were recorded major adverse cardiac events(all-cause mortality, myocardial infarction, Target vessel revascularization) asthe end point. Continuous variables are described as mean value±SD,whereas dichotomous variables are described as numbers and percentages.Differences between patients in the different groups were analyzed by Studentt tests (continuous data) or chi-square tests (dichotomous data). A P value of＜0.05was considered significant.Results: All71patients completed clinical or telephone follow-up within 12months. There were no significant differences in baseline clinicalinformation including age，gender, Diabetes，Hypertension, Hyperlipidemia,Current smoker, Family history of CAD, heart function(left ventricle ejectionfraction. LVEF) among the3groups. There were no significant differences inthe distribution of lesions among A group (LAD15, LCX8, RCA7,50％,26.67％and23.33％respectively), B group (LAD11, LCX5, RCA4,55％,25％and20％respectively) and C group (LAD10, LCX6, RCA5,47.62％,28.57％and23.81％respectively), P＞0.05. there were also no significantdifferences in the diameter stenosis among A group(58.93±5.45%), Bgroup(57.55±4.96%), C group(58.38±4.78%), P＞0.05. Fractional flowreserve was0.85±0.02in the A group,0.64±0.07in the B group, and0.66±0.06in the C group. The difference between the first and second FFRmeasurement was0.03±0.02. All the patients of B groups received PCItherapy; the surgery achievement ratio reached100%, coronary flow ofdisease lesion received TIMI grade3, with no complication such as coronaryperforation, coronary dissection, acute stent thrombosis etc. Aspirin was usedby all the patients during the study. Use of antianginal and lipid-loweringdrugs was similar in all three groups. Clopidogrel use as a standard drugbefore coronary artery angiography, and continue using only when stent wasplaced at least12months post PCI therapy. Major adverse cardiac events of1year were significantly lower in the B group10%than in the C group38.10%，P=0.036. There was no significant difference between A and B group in majoradverse cardiac events（6.67%vs.10%，P=0.670）. Follow-up of1year wassignificantly lower in the A group6.67%than in the C group38.10%，P=0.005.Conclusion:1Clinical prognosis of FFR≥0.75coronary borderline lesion patientswith conservative medical therapy was similar with that of patients whom FFR＜0.75and PCI was performed.2Coronary borderline lesion Patients with FFR＜0.75performed PCIcould benefit more than deferred PCI. Fractional flow reserve guided percutaneous coronary intervention ofborderline lesion based on FFR＜0.75has clinical significance. |
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