| Objective:1. To analyze the treatment effect of Fractional Flow Reserve guided versus angiography guided percutaneous coronary intervention in coronary borderline lesions; 2. To analyze the appropriateness of myocardial FFR> 0.8 guided medical treatment in coronary borderline lesions; 3. 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.Method:1. Choose the patients with borderline lesions through coronary angiography who accepted FFR to guide PCI in the Cardiology Department of the First Affiliated Hospital of Kunming Medical University from October 2014 to December 2015. There were 22 cases with 33 vessels were registered, which were matched as 1:1 with the patients with borderline lesions guided by coronary angiography by the same doctor in the same period. There were 26 cases with 33 vessels were registered. Observed the major adverse cardiovascular events (including cardiac death non-fatal myocardial infarction target vessel revascularization) and the catabatic level of angina in 1,3,6,12months after operation.2. Choose the patients with borderline lesions who accepted optimized medical treatment based on FFR>0.8, there were 12 case with 18 vessels were registered, and observed the major adverse cardiovascular events (including cardiac death non-fatal myocardial infarction target vessel revascularization)and the catabatic level of angina in more than 12 months after operation.Result:1. FFR PCI group contained 9 cases with 14 vessels; FFR medical group contained 13 cases with 19 vessels; CAG PCI group contained 9 cases with 13 vessels; CAG medical group contained 17 cases with 20 vessels. The mean of FFR after PCI was 0.93±0.04 while it was 0.78±0.02 before PCI in the FFR PCI group, and all 3 cases’s FFR> 0.90 contained 1 case’s FFR=0.97 after PCI, which achieved a favorable result. Compared with CAG-guided patients, FFR-guided patients had excellent results.There were no cardiac death, non fatal myocardial infarction and revascularizat ion in the 4 groups during follow-up.Between the two groups compare FFR interventi onal treatment group with the FFR drug group angina relief was similar, the differenc e was not statistically significant; CAG in the intervention group than in the drug grou p after the relief of angina pectoris is good, the difference was statistically significant (P<0.05); FFR guidance of the two groups and CAG in the interventional treatment group after the treatment of angina pectoris relief is similar, the difference was not sta tistically significant (P>0.05); FFR guidance for the treatment of the two groups than t he CAG drug group angina relief is good, the difference was statistically significant ( P<0.05).2. The 12 patients with 18 vessels of borderline lesions in FFR medical group who’s follow-up time is more than 1 year have a mean age 617.49 years and a mean follow-up time 15.5 1.76, no one lose.2 patient had angina pectoris after FFR but not aggravating than before, and the angina can be relieved by take medicine (16.7%), and the other patients have no angina pectoris after FFR, all patients have no the major adverse cardiovascular events (including cardiac death non-fatal myocardial infarction target vessel revascularization). The mean time of angina occurred after FFR was 16.48±0.43.Conclusion:1.FFR can identify exactly whether it was isch emia or not in borderline lesion of angina pectoris cases, PCI guided with FFR versus CAG-guided in borderline lesions can better relieve symptoms and improve prognosis; But if based on FFR<0.8 or FFR<0.75,we want to know whether the FFR guided PCI group can get a more better result and we will do the further study; Based on FFR>0.8, it is safe for the patient of borderline lesion to choose optimum medical treatment.2. FFR detection technology is safe and easy to operate, but we need to pay attention to the details of the operation in order to avoid affecting the FFR results by operational problems. The accuracy of FFR results may be affected by drug selection or route of administration, etc. Which were used to induce maximum hyperemia of myocardial.3. There are no special adverse reactions with rapidly intravenous infusion of ATP intraoperative, most patients can tolerate with that, but still need to wary about malignant arrhythmias and other serious consequences that may occur, except some patients with adenosine relevant contraindications strictly, be ready for drugs, devices to rescue at any time. |
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