| backgroundCoronary Angiography(CAG)is the "golden standard" for clinical diagnosis of coronary heart disease(CHD).In order to evaluate coronary artery more accurately and reliably,morphological and functional assessment of vessels has been further developed in the field of coronary intervention.Since the establishment of the Fractional Flow Reserve(FFR)in 1993,FFR has attracted worldwide attention with the advantage of "providing evidence of whether the myocardium is ischemic".After researching for many years,FFR has been explicitly recommended by European and Asian guidelines.However,the operation of FFR is complex,time-consuming and risky,Adenosine is expensive and causes many adverse reactions,and patients with chronic obstructive pulmonary disease,bronchial asthma and other diseases can not be measured by FFR.The derivative technology of FFR,instantaneous Wave-Free Ratio(iFR),has attracted much attention since it was launched.iFR is supported by many clinical studies in the world because of its non-inferiority,safety,convenience and stability.However,the results of iFR-guided coronary intervention have few been published in China.This study was based on Chinese patients with coronary borderline lesion to study the correlation and diagnostic value of iFR and FFR.While the FFR cutoff value was 0.80,this study explored the best cutoff value of iFR among Chinese patients.iFR is applied to interventional therapy of Chinese patients with coronary single borderline lesion,Whether iFR-guided functional revascularization of coronary artery improve clinical prognosis and bring greater benefits to patients.We designed and implemented this study to further confirm the value of iFR in coronary borderline lesion.purposeA comparative study of iFR and FFR was conducted in Chinese patients with coronary borderline lesion to compare their diagnostic ability for myocardial ischemia and to study the correlation and diagnostic value of iFR and FFR.At the same time,the prognosis of patients with coronary single borderline lesion guided by FFR and iFR was compared,which provided evidence for the application of iFR in China,and may provide alternative means for patients with contraindication of FFR detection.method1.Consider patients with coronary heart disease,who received coronary angiography with both iFR and FFR measurements in Huaihe Hospital of Henan University from May 2015 to October 2018,showed 50%-70% stenosis.A total of 40 patients(51 lesions)were included.Define FFR≤0.80 is positive and FFR>0.80 is negative;iFR≤0.89 is positive,and iFR>0.89 is negative.First,calculate the correlation between the application of iFR and FFR and their diagnostic value.Define FFR>0.80 is negative,and calculate the best cutoff value of iFR in the Chinese patients with coronary borderline lesion.2.Consider patients with 50%-70% single stenosis showed by coronary angiography,who were from Huaihe Hospital of Henan University and the Seventh People’s Hospital of Zhengzhou from May 2015 to March 2018.The 42 patients who underwent functional revascularization under the guidance of iFR were included in the iFR group and were implanted with drug eluting stents(DES)if their iFR values≤0.89.The 45 patients who underwent functional revascularization under the guidance of FFR were included in the FFR group and were implanted with drug eluting stents(DES)if their FFR values≤0.80.All the drug-eluting stent implantations were successful and postoperative coronary blood flow was Grade 3 in the thrombolysis in myocardial infarction(TIMI),and there was no coronary perforation,dissection,acute thrombosis or other serious complications.The general baseline data,risk factors and interventional therapy were compared between the two groups,The recurrence rate of angina pectoris and the incidence of major adverse cardiovascular events(MACE)were followed up for 12 months.result1.Compared iFR with FFR:sensitivity is 89.3%,specificity is 91.3%.The positive predictive value is 92.6%,the negative predictive value is 87.5%,the total coincidence rate is 90.2%,and the Yoden index is 80.6%.Cohen’s kappa coefficient is 0.803,with P < 0.05.The result is statistically significant.2.The receiver operating characteristic curve(ROC)curve indicated that the marker FFR threshold value was 0.80,the ROC curve indicated that the best cutoff value of iFR was 0.89.The area under the curve is 0.913.The 95% confidence interval is 0.829-0.997,P <0.05,with statistical significance.3.The iFR group included 42 patients,6 of which were implanted stents;the FFR group included 45 patients,10 of which were implanted stents.Statistical analysis showed that there was no statistical difference in general baseline data and risk factors between the two groups,and there was no statistical difference in the number of stents implanted,the location of stents implanted,the length of stents implanted and the amount of contrast media used between the two groups(P > 0.05).However,the incidence of adverse reactions and operation time in iFR group were significantly lower than those in FFR group(P < 0.05).4.By statistical analysis of 12-month follow-up results,the cardiogenic mortality and sudden myocardial infarction rate of the FFR group were 0%(0 cases),and the iFR group had a cardiac death rate and a sudden myocardial infarction rate of 0%(0 cases),For example,the FFR group had a revascularization rate of 4.4%(2 cases),and the iFR group had a revascularization rate of 2.4%(1 case).The difference was not statistically significant(P>0.05).The incidence of MACE in the FFRl group was 4.4%(2 cases),and the incidence of MACE in the iFR group was 2.4%(1 case).The difference was not statistically significant(P>0.05).The angina pectoris rate was 11.1%(5 cases)in the FFR group,and the angina pectoris rate was 7.1%(3 cases)in the iFR group.The difference was not statistically significant(P>0.05).Conclusion1.In coronary borderline lesion,iFR has strong consistency and correlation.The accuracy and reliability of iFR are high.The diagnostic efficiency is the highest when the FFR threshold value is 0.80 and the iFR threshold value is 0.89.2.Coronary single borderline lesion PCI guided by iFR threshold value of 0.89 is not only not inferior to the effect of PCI guided by FFR,but also safe.iFR is easy to operate and can reduce the operation time and adverse reactions during operation.3.iFR can recommend alternative examinations for patients with contraindication of FFR detection as well as coronary heart disease who has coronary single borderline lesion. |
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