| Objective:1) To compare the value of FFR and CAG in evaluating patients with coronary intermediate stenosis; Evaluate the clinical value of FFR in PCI; 2)Investigate the treatment strategies for patients with coronary intermediate stenosis, whose FFR ranging from 0.75 to 0.80.Method:In this study, patients with suspected coronary heart disease in Sichuan Provincial People’s Hospital from 02/2013 to 02/2014 were enrolled. Finally, 49 patients with single coronary intermediate stenosis(50%-70%) diagnosed by QCA measurement were studied. All the 49 patients were randomly divided into two groups: CAG group(25 cases) and FFR group. All the patients in CAG group were treated with PCI; In FFR group, patients whose FFR>0.8(8 cases) were given conservative treatment; patients whose FFR<0.75(3 cases) were treated with PCI; patients whose FFR ranging from 0.75-0.8 were randomly given conservation treatment(6 cases) or PCI(7 cases). All the clinical data including QCA measurements(vascular stenosis, diameter of reference vessel and minimal lumen diameter), hospitalization duration, amount of contrast agent had been used, number of patients accepted stent implantation and the costs of treatment materials were collected; all patients had a 12 months follow-up. The primary endpoints in this study were the occurrence of MACE(cardiac death, non fatal myocardial infarction, re-vascularization), the secondary endpoints were including recurrence of angina pectoris, number of stents had been used, amount of contrast agent had been used, hospitalization time, and etc.Result: After 12 months follow up, the endpoints were analyzed in each group. 1)Part I: neither cardiac death nor non-fatal myocardial infarction occurred in both FFR group and CAG group; there was 1 patient accepted re-vascularization in the group whose FFR ranging from 0.75-0.8; the incidence of MACE was 4.2% in FFR group vs 0 in CAG group(P =0.302); the occurrence of recurrent angina pectoris is 12.5% in FFR group vs 20% in CAG group(P =0.478), the difference was not statistically significant. Contrast drugdosages were 83.95± 24 ml in FFR group and 106.60 ±28.01 ml in CAG group(p=0.004); the average number of stent had been implanted in FFR group were 0.51 ±0.34 and 1.36 ±0.48 in CAG group(P < 0.001); the costs of medical materials been used were 29890.33±11327.13 RMB in FFR group and 37428±6857.40 RMB in CAG group(P =0.007); postoperative hospital stay(days) were 2.62 ± 1.05 and 3.44 ± 0.71 in FFR and CAG group(P =0.003). 2) Part II:neither cardiac death nor non-fatal myocardial infarction were occurred in patients with medicine treatment(whose FFR is either >0.80 or FFR ranging from 0.75-0.80); there was 1 patient accepted re-vascularizationin treatment in the group whose FFR ranging from 0.75-0.8; in two medicine treatment groups, the incidence of MACE was 0% in patients with FFR>0.80 and 16.7% in patients with FFR ranging from 0.75-0.80(P =0.231); the incidence of recurrent angina pectoris was 0 in patients with FFR>0.80 and 16.7% in patients with FFR ranging from 0.75-0.80(P =0.231); Part III: neither cardiac death nor non-fatal myocardial infarction were occurred in patients with FFR ranging from 0.75-0.80(patients were treated either by PCI or drug); one patient in medicine treatment group accepted re-vascularization treatment whose FFR ranging from 0.75-0.80; for patients with intermediate coronary stenosis and whose FFR ranging from 0.75-0.80, the incidence of MACE were 0% vs 16.7% in PCI and medicine treatment group(P =0.261), incidence of recurrent angina were 14.3% vs 16.7% in PCI and medicine treatment group(P =0.906), respectively.Conclusion: 1) FFR is prior to CAG for security, efficiency and economic benefits in the treatment assessment for patients with coronary intermediate stenosis; 2)it’s benefit for patients, whose fractional flow reserve(FFR) is ≥0.80, to take medicine treatment;3) For patients with intermediate coronary stenosis(whose FFR ranging from 0.75-0.80), it’s necessary to make a personalized treatment plan according to their symptoms, laboratory results and anatomical characteristics of coronary lesion. |
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