Comparative Study Of Fractional Flow Reserve-guided And Angiography-guided Percutaneous Coronary Intervention In Coronary Bifurcation Disease

BackgroundCoronary bifurcation lesion is one of the difficulties in Percutaneous Coronary Intervention(PCI),complications,stent restenosis rate is high,poor in prognosis compared with a single lesion.As the bifurcation lesions involving two or more vessels,the marginal branch opening is often covered by the main branch of the blood vessels when coronary angiography(CAG),multi-position proj ection still cannot fully expose the lesions.Therefore,accurate assessment of ischemic lesions of bifurcation lesions,selectively and active intervention in myocardial ischemia related lesions,can significantly improve the patients prognosis,reducing the incidence of cardiovascular events.Fractional flow reserve(FFR)is considered to be the specific function parameters of the epicardial coronary artery lesion.Compared with coronary angiography,FFR can identify ischemic lesions quickly.The aim of this study is to elucidate the role of FFR in guiding bifurcation treatment strategies.MethodsA totle of 156 patients with coronary bifurcation lesion were selected from January 2014 to December 2016,and they were randomly into FFR group and CAG group,each of 78 cases.Patients of FFR group received coronary FFR guided PCI for side branch,while CAG group received CAG guided PCI for side branch.Proportion of patients undergo stent implantion,number and length of implanted stents,duration of surgery and hospital stays were compared between the two group.Comparative analysis was made on the QCA and FFR results of the side branches in FFR group.Major adverse cardiovascular events(target vessel revascularization,angina,death,myocardial infarction)were recorded during 12 months follow up.Results1.Proportion of patients undergo stent implantion of FFR group was statistically less than CAG group(10.3%vs21.8%,P<0.05);number and length of implanted stents of FFR group was statistically less than CAG group(1.37±0.36vs1.72±0.42,32.5 ± 17.4vs38.4± 18.1mm,P<0.05);2.After main branch stent implantation,in the FFRgroup,there are 24 patients of QCA diameter stenosis?70.0%,41.7%of the patients FFR?0.8,58.3%of the patients FFR<0.8;there are 54 patients of QCA diameter stenosis<70.0%,88.9%of the patients FFR?0.8,11.4%of the patients FFR<0.8;There was a negative correlation between the stenosis and FFR of side branch(r=-0.244,P=0.031);3.Logistic analysis show that the angle between main vessel and side branch<70°;the side branch<2.5mm,stenosis?70%and the length of stenosis?5mm were more complex in the decline of FFR;4.After 12 months follow up,MACE in FFR group was statistically less than CAG group(10.3%vs20.5%,P<0.05).Conclusion.1.Compared with CAG guided PCI for side branch,FFR guided PCI for side branch preferably reduce the necessity of stent implantation and number of implanted stents,shorten the length of implanted stents;2.Side branch have functional significance after stent implantation in the main vessel.The angle between main vessel and side branch,the diameter,stenosis and lesion length of side branch are correlative risk factors;3.FFR can improve the efficiency of diagnosis in the treatment of coronary artery bifurcation,thus is helpful to reduce the MACE.