冠状动脉血流储备分数（FFR）的临床应用课件.ppt

* The characteristics of FFR have been extensively described and validated over recent years. It has a sharp cut-off value to indicate inducible ischemia. FFR0.75 always indicates ischemia; FFR 0.80 excludes ischemia in 90% of the cases. The grey zone is very limited, which is important for clinical decision-making in an individual patient. 结论： 在冠脉中度狭窄的患者中，FFR是一个非常有用的指标，用于评价狭窄病变的功能学意义，确定冠脉血运重建的必要性。 The DEFER study is a prospective, randomized, multi-center study including 325 patients scheduled for PCI without proof of ischemia. According to the study protocol: - If FFR 0.75: PCI. - If FFR 0.75: randomization DEFER or PCI. The purpose of the study was to discriminate between when PCI will help and when it will be of no use. The conclusion of the study was that in patients with a coronary stenosis without evidence of ischemia, coronary pressure-derived FFR identifies those patients who will benefit from PTCA. It was found that approximately 50% of patients with intermediate lesions do NOT need intervention, will NOT benefit from it, and in whom it might even be detrimental. DEFFER研究五年随访-针对单根血管 背景：对没有缺血证据的中度狭窄的病变行PCI手术，其益处还没有被证明过。目的是研究对没有功能性意义的狭窄病变行PCI的恰当性。 方法：325个有中度狭窄的患者。 分成三个组：Defer组，Reference组，Perform组。随访五年之后的无心脏事件的生存率。 BACKGROUND: PTCA of a coronary stenosis without documented ischemia at noninvasive stress testing is often performed, but its benefit is unproven. Coronary pressure-derived fractional flow reserve (FFR) is an invasive index of stenosis severity that is a reliable substitute for noninvasive stress testing. A value of 0.75 identifies stenoses with hemodynamic significance. METHODS AND RESULTS: In 325 patients for whom PTCA was planned and who did not have documented ischemia, FFR of the stenosis was measured. If FFR was 0.75, patients were randomly assigned to deferral (deferral group; n=91) or performance (performance group; n=90) of PTCA. If FFR was 0.75, PTCA was performed as planned (reference group; n=144). Clinical follow-up was obtai