The Analysis Of Fractional Flow Resevre Guiding On Delay PCI With Coronary Intermediate Lesion

Objectives This study was to determine whether FFR- guided PCI treatment is necessary under the guide of Fractional Flow Reserve(FFR) in patients with coronary angiography prompting intermediate lesions. Severe angina attack, positive treadmill exercise test(TET) and major adverse cardiovascular events(MAC E) were follow- up after 1- month, 6- month, 12- month, in order to evaluate the value of FFR- guided delayed PCI for coronary intermediate lesions.Methods 94 patients in- hospital with unstable angina were selected continuously in Hospital of Cardiology, from January 2014 to November 2014, who were accepted coronary angiography(C AG) showed the limitations of intermediate lesions. And lesion diameter stenosis(DS) rate was betwee n 50%-70%. Lesions reference vessel diameter(RD) in patients greater than 2.5mm in 94 cases. Divided into three groups, CAG drug treatment group, FFR delay treatment group, FFR interventional therapy group. CAG drug treatment group were 34 patients and we re treated with only optimal drug therapy,FFR delay treatment group that FFR>0.75 were 30 patients and were only given standard drug therapy for secondary prevention of coronary heart disease,While,FFR interventional therapy group that FFR?0.75 were 30 patients and were treated with PCI, implanted drug-eluting stents. All patients were treated with optimized secondary prevention of coronary heart disease treatment. They were observed and followed up during follow-up of TG,LDLC,HDL,LDH,CK,CK-MB,c TN-I,NT-pro BNP,LVEF(Left ventricular ejection fractio),TET changes respectively after 1-month,6-month,12- month beteen the three groups,besides follow-up of MAC E(including death, nonfatal myocardial infarcttion, target vessel revascularization), as well as severe angina attack cases(CCS angina ? and above), which was to assess whether there were statistical differences beteen three groups, especially FFR-Delayed group.Results All 94 patients were followed up, no one lost. The results showed that there was no statistically significant difference in baseline clinical information among the three groups(P>0.05) including age, gender, smoking, Hypertension,Hyperlipidemia, Diabetes, laboratory indicators(TG, HDL, LDH, CK, CK-MB, c TN-I, NT-pro BNP), LVEF,FFR interventional group was implanted with 34 stents(1.10±0.30). All stents were implanted successfully, and the blood flow reached TIMI 3 level after operation. Three groups of patients were treated with optimal drug medical therapy, carried out secondary prevention of coronary heart disease. There was no significant difference in baseline data between the three groups. There was no statistically significant difference(P>0.05) besides MACE,TET,severe angina attacks in three groups after followed- up of 1-month, 6- month. The follow-up result of 12- month was shown there was no significant statistical significance(P>0.05) in the three groups of patients with MACE,There were significant differences in the positive of TET between the three groups(P<0.05),The CAG drug treatment group was the highest, FFR delay treatment group centered, FFR group of interventional therapy was the lowest. Pairwise comparisons showed that there were significant differences beteen FFR interventional treatment group and C AG drug treatment groups, meanwhile, between FFR dela y treatment and CAG drug treatment group. The difference between FFR intervention group and FFR delayed treatment group was not significant(P>0.05). There was significant statistical significance beteen the three groups of cases in terms of severe angina a ttacks(P<0.05), CAG drug treatment grouphad the highest incidence. Pairwise comparison showed that:there was significant statistical significance beteen FFR intervention treatment group and CAG drug treatment group in terms of postive TET(P<0.05); there were no significant differences beteen FFR interventional treatment group and FFR delay treatment, meanwhile, between FFR delay treatment and CAG drug treatment group. The coronary borderline lesions showed the positive TET were prone to be PCI.Conclusions 1 FFR was safe and reliable in guiding coronary intermediate lesion PCI,FFR delayed PCI drug treatment did not increase the risk of MACE. 2 FFR- guided PCI for intermediate lesions can reduce the incidence of severe angina attacks, positive TET, improve myocardial ischemia, increase exercise tolerance. FFR delayed PCI also improve myocardial ischemia, increase exercise tolerance.