The Impacts Of Changes In PCI Strategy Under The Guidance Of FFR On Patient Prognosis

Background:Coronary heart disease(CHD)is a series of diseases that point to the artery that provides blood to the heart,that is,coronary artery atherosclerosis causes lumen stenosis or occlusion,which leads to myocardial ischemia,hypoxia or necrosis,and then leads to varying degrees of chest pain,chest tightness,suffocation and other discomfort.In severe cases,it can be life-threatening.For the diagnosis of coronary heart disease,coronary angiography(CAG)has always been regarded as the "gold standard",but in critical coronary artery lesions and some functional ischemic lesions,CAG is defective in judging whether there is insufficient perfusion in the myocardium at the distal end of coronary artery lesions.Fractional flow reserve(FFR)is a functional and physiological index to evaluate coronary blood flow.It is defined as the ratio of the maximum blood flow provided by the coronary artery to the maximum blood flow that can be obtained by the myocardium without stenosis.Many studies have also proved that FFR can accurately diagnose critical lesions.It can help us judge whether coronary artery lesions cause myocardial ischemia from the perspective of function and physiology.In the actualprocedureprocess,the intervention strategy formulated by the operator after coronary angiography can often be changed under the guidance of FFR.The visual non ischemic lesions may receive PCI,while the ischemic lesions not identified on angiography may adopt the strategy of conservative treatment.Objective: To explore whether the changes of PCI strategy under the guidance of FFR has a positive impact on the prognosis of patients and the influence of FFR on the decision-making of interventional physicians,and to confirm whether FFR has greater clinical application value.Methods: A total of 600 patients with coronary heart disease with at least one coronary artery with moderate stenosis(50-90%)were analyzed in the Department of Cardiology of the heart center of our hospital from September 2016 to June 2021.Among them,300 patients in the experimental group were treated with PCI under the guidance of FFR,and300 patients in the CAG group were treated with treatment strategies under the guidance of coronary angiography only.After 600 patients were discharged from the hospital,the coronary angiography results of all the patients were collected,and 23 experienced cardiac interventional cardiologists in our center reviewed the films,designated the treatment strategy in combination with the patient’s medical history,symptoms and age,and reviewed the treatment strategy after FFR examination by consulting the procedure records,The number of patients who changed the treatment strategy(FFR group A)and the number of patients who did not change the treatment strategy(FFR group B)were counted.Based on the results of the FFR test,the number of people who took PCI treatment(FFR-PCI group)and the number of people who underwent conservative drug treatment(FFR-drug group)were counted.All the patients were followed up for 6 months to 1 year after procedure.The follow-up methods included telephone follow-up,outpatient follow-up and inpatient follow-up.Forty-two patients lost the follow-up.Finally,558 patients were included in the study,including 272 in the CAG group and 286 in the FFR group.The baseline data of patients were observed Differences in coronary angiography and PCI data and major adverse cardiovascular event(MACE)(including cardiac death,myocardial infarction,revascularization and angina pectoris attack)between the CAG group and the FFR group and between FFR groups A and B.Results : The clinical data of patients with hypertension,smoking and diabetes were compared between groups,smoking,hypertension,diabetes,hyperlipidemia,left ventricular ejection fraction,myocardial infarction,PCI history,degree of stenosis of diseased vessels,number of diseased vessels and other factors There was no significant difference between them(P > 0.05).There was no significant difference in procedure times between the two groups(P > 0.05);The number of stents and the amount of contrast medium used in FFR group were lower than those in the CAG group(P < 0.05),the length of hospital stay was significantly shorter than that in the CAG group(P < 0.05),and the incidence of adverse cardiovascular events in the FFR group was lower than that in the CAG group(P < 0.05).There were 121(42.3%)in FFR group A and 165(57.7%)in FFR group B,There was no significant differences in the incidence of adverse cardiovascular events between FFR group A and FFR group B(P > 0.05).There were 202 people in the FFR-PCI group and 84 people in the FFR-drug group,and there was no significant difference in the incidence of adverse cardiovascular diseases between the FFR-PCI group and the FFR-drug group(P>0.05).Conclusion:For patients with critical coronary lesions,coronary angiography combined with FFR can reduce the number of stents,the use of contrast agents,shorten the length of hospital stay,and reduce the incidence of adverse cardiovascular events.FFR has a significant impact on the decision of PCI strategy,and the change of strategy has no significant impact on the prognosis of patients.Therefore,FFR detection has high application value for patients with coronary critical lesions.