| Object:Coronary atherosclerotic heart disease is due to coronary atherosclerosis which causes Luminal stenosis or obstruction, or(and) coronary artery spasm, leading to the lesion of coronary artery blood supply of the corresponding myocardial ischemia, hypoxia, or a cardiac necrosis When the coronary angiography shows the stenosis is 50%-70%, the lesions is called the Coronary intermediate lesion, which may cause myocardial ischemia.Coronary arteriongraphy is the ‘gold standard’ of the diagnosis of coronary heart disease. However, the single morphology method, which shows only the contours of the arterial lumen filled with contrast agent rather than to determine the pathological changes in the local structure of the vascular wall, cannot make a fully functional judgment on the coronary artery narrowing and the forecast of the short-term and long-term prognosis. From the perspective of pathology, coronary atherosclerosis is a diffuse pathological change and the suffered coronary always presents the pathological changes which locates in multiple sites or are diffuse. The so-called near normal coronary artery which is showed by coronary angiography is not the normal reference vessel in the true sense. The suffered coronary vascular tissue structure during the process of atherosclerosis may exist remodeling in different degrees. As a result, in the 1990 s, Dutch scholar Nico Pijls raised the concept of fractional flow reserve(FFR), which refers to the ratio of the maximum blood flow of coronary artery stenosis and the maximum blood flow to the same arterial blood flow which is normal. FFR is a physiology index which can reflect the degree of the stenosis and the range of specific arterial blood supply. Pijls research laid the theoretical and practical foundation for the functional revascularization. In the aspect of the assessment of myocardial ischemia, the accuracy of FFR is much higher than the non-invasive ECG exercise test, stress echocardiography, isotope myocardial perfusion scan, or other tests.So, how to make a functional judgment on the coronary intermediate lesion? As a simple, reliable and reproducible physiological indicator, FFR has been widely used in the examination of the coronary artery disease of the hemodynamic significance.FFR is an effective means to evaluate the patients’ true statement of coronary stenosis lesions of myocardial ischemia, and guide the percutaneous coronary stent implantation(PCI), in order to reduce the economic burden and risk of surgery caused by the unnecessary treatment.This research aims to investigate the application value of Fractional Flow Reserve(FFR) in the coronary intermediate lesion diagnosis and treatment. Methods:60 patients whose coronary artery stenosis is in 50%-70% by receiving coronary angiography check of conventional Judkins method during January 2013 and August 2014 are retrospectively analyzed. The exclusion criteria of the patients: severe liver and kidney dysfunction, cardiomyopathy, valvular heart disease, heart failure, multi-vessel occlusion. Patients are divided into three groups according to the FFR value compared with 0.75: if FFR≤0.75, patients belongs to the group of not to intervene while only medication; if FFR<0.75, patients are randomly divided into instant intervened group and the delay intervene while only simple medication. Patients were followed up for 6 months. Recording the occurrence times of Major adverse cardiac event(MACE) of patients, such as Ischemic chest pain recurred target lesion revascularization, stent stenosis, nonfatal myocardial infarction. Evaluate the severity of coronary artery disease of three groups of patients as well as the guidance on intraoperative and postoperative assessment. Use SPSS16.0 to analyze all the data. Measurement data uses mean ± standard deviation( X ±S) to represent; normal distribution uses the t test; categorical variables uses chi-square(X2) test. P <0.05 is considered statistically significant. Results:Finally we finished 6-month follow-up of the 60 cases, summed up three groups, of coronary angiography suggested as critical disease patients, and they have no statistically significant difference in the basic clinical characteristics, like gender, age, hypertension, diabetes, high cholesterol, smoking, abnormal liver function, renal dysfunction, family history of coronary heart disease, heart ejection fraction(LVEF), which the value is below 50%. All three groups got the oral aspirin therapy. Three groups have no significant difference in the oral nitrates, β-blockers, angiotensin-converting enzyme inhibitors(ACEI)/angiotensin II receptor blocker(ARB), and other statins medicine. All patients had oral clopidogrel bisulfate treatment before the surgery. Three groups of patients based on clinical characteristics of gender, age, hypertension, diabetes, high cholesterol, smoking, abnormal liver function, renal dysfunction, family history of coronary heart disease, heart ejection fraction(LVEF) was no statistically significant difference. Only group which accept immediate PCI and those need target vessel revascularization in other groups continue the oral clopidogrel bisulfate treatment after the surgery. For group A which accept only medicine treatment and whose FFR≥0.75, no major adverse cardiovascular events occurred during hospitalization, and zero cases of acute myocardial infarction, two cases of recurrent angina symptoms and in total, two cases of adverse cardiovascular events(10.0%) happened. For group B which accept immediate PCI treatment and whose FFR<0.75, no major adverse cardiovascular events occurred during hospitalization, and one case of acute myocardial infarction, two cases of recurrence with angina pectoris considering of the stent thrombosis, and in total, three cases of adverse cardiovascular events(15.0%) happened. For group C which accept delayed PCI treatment, three cases of angina attack again during hospitalization, and two cases of acute myocardial infarction, four cases of recurrent angina, and in total, nine cases of adverse cardiovascular events(45.0%) happened. Among three groups, both group B and group C’ incidence of major adverse cardiovascular events has been significantly reduced and has significant statistical difference. The incidence of major adverse cardiovascular event of group A is lower than which of group B which accepts immediate PCI treatment, however with no significant statistical difference. Group A which accept the conservative medicine treatment has significant statistical difference with group C which accepts the delayed PCI treatment, in the incidence of major adverse cardiovascular events. Conclusions:1.CHD patients with the intermediate lesion should physiological function evaluation to guide the interventional treatment. For FFR<0.75, the incidence of adverse cardiovascular events of patients accept the immediate PCI treatment is significantly lower than that of patients accept the delayed PCI treatment.2.Method to measure the FFR value is simple and the result is accurate and at the same time, patients suffer little wound. It has a good clinical significance on judging the impact of coronary stenosis on vascular function and whether or not doing the revascularization. |
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