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首页> 美国卫生研究院文献>Journal of Clinical Medicine >Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography Safely Defers Invasive Coronary Angiography in Patients with Stable Coronary Artery Disease
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Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography Safely Defers Invasive Coronary Angiography in Patients with Stable Coronary Artery Disease

机译：冠状动脉计算机断层扫描血管造影术所产生的分数血流储备可安全地防御稳定型冠状动脉疾病患者的侵袭性冠状动脉血管造影术

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Objectives: In the United States, the real-world feasibility and outcome of using fractional flow reserve from coronary computed tomography angiography (FFR ) is unknown. We sought to determine whether a strategy that combined coronary computed tomography angiography (CTA) and FFR could safely reduce the need for invasive coronary angiography (ICA), as compared to coronary CTA alone. Methods: The study included 387 consecutive patients with suspected CAD referred for coronary CTA with selective FFR and 44 control patients who underwent CTA alone. Lesions with 30–90% diameter stenoses were considered of indeterminate hemodynamic significance and underwent FFR . Nadir FFR ≤ 0.80 was positive. The rate of patients having ICA, revascularization and major adverse cardiac events were recorded. Results: Using coronary CTA and selective FFR , 121 patients (32%) had at least one vessel with ≥50% diameter stenosis; 67/121 (55%) patients had at least one vessel with FFR ≤ 0.80; 55/121 (45%) underwent ICA; and 34 were revascularized. The proportion of ICA patients undergoing revascularization was 62% (34 of 55). The number of patients with vessels with 30–50% diameter of stenosis was 90 (23%); 28/90 (31%) patients had at least one vessel with FFR ≤ 0.80; 8/90 (9%) underwent ICA; and five were revascularized. In our institutional practice, compared to coronary CTA alone, coronary CTA with selective FFR reduced the rates of ICA (45% vs. 80%) for those with obstructive CAD. Using coronary CTA with selective FFR , no major adverse cardiac events occurred over a mean follow-up of 440 days. Conclusion: FFR safely deferred ICA in patients with CAD of indeterminate hemodynamic significance. A high proportion of those who underwent ICA were revascularized.
机译：目标：在美国，使用冠状动脉计算机断层扫描血管造影术（FFR）的分数血流储备的现实可行性和结果尚不清楚。我们试图确定与单独的冠状动脉CTA相比，结合冠状动脉计算机断层扫描血管造影（CTA）和FFR的策略是否可以安全地减少对有创冠状动脉造影术（ICA）的需求。方法：该研究包括387例连续的疑似CAD患者，其中有选择性FFR的冠状动脉CTA患者和44例仅接受CTA的对照患者。直径狭窄度为30–90％的病变被认为具有不确定的血液动力学意义，并接受了FFR。最低FFR≤0.80为阳性。记录患有ICA，血运重建和主要不良心脏事件的患者的比率。结果：使用冠状动脉CTA和选择性FFR，121例患者（32％）至少有一根血管狭窄≥50％； 67/121（55％）患者的至少一条血管的FFR≤0.80； 55/121（45％）接受了ICA；和34进行了血运重建。接受血管重建术的ICA患者比例为62％（55/34）。狭窄直径为30–50％的血管的患者人数为90（23％）； 28/90（31％）患者至少有一条血管的FFR≤0.80； 8/90（9％）接受了ICA；另有五人进行了血管重建。在我们的机构实践中，与单独的冠状动脉CTA相比，具有选择性FFR的冠状动脉CTA降低了阻塞性CAD患者的ICA率（45％比80％）。使用具有选择性FFR的冠状动脉CTA，在平均440天的随访中，没有发生重大的不良心脏事件。结论：FFR可安全地延迟具有不确定血流动力学意义的CAD患者的ICA。接受ICA的患者中有很大一部分进行了血运重建。

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