Abstract
Background: Coronary artery disease is the most common cause of death in a modern world. This dictates the development a network of Catheterization laboratories without cardiosurgical capabilities.Aim: We postulate that the most valuable tool in the decision process on myocardial revascularization is fractional flow reserve (FFR), especially when we deal with borderline coronary lesions.Material and Methods: A total of 72 patients with 94 intermediate coronary stenosis (30%-70% diameter reduction) were included in this study. We tested FFR and angiography based decision model on myocardial revascularization.Results: Â Mean FFR value on left anterior descending coronary artery (LAD) was lower than in others two arteries (p=0.017). FFR after percutaneous coronary intervention (PCI) was significantly better (p<0.0001). The decision for PCI predominates before FFR diagnostics, but after FFR the decision is quite opposite. There is a weak negative correlation between FFR and diameter of stenosis assessed by angiography (r= - 0.245 p=0.038) and positive correlation between diameter of stenosis assessed by angiography and by quantitative coronary angiography (QCA) (r=0.406 p<0.0005).Conclusion: Â Our results strongly suggest that FFR is necessary tool in centers without possibilities of heart team onsite consultation and that prevents numerous unnecessary PCI.
Highlights
The functional significance of coronary artery stenosis of intermediate severity is important in determining revascularization strategy in patients
The decision for percutaneous coronary intervention (PCI) predominates before fractional flow reserve (FFR) diagnostics, but after FFR the decision is quite opposite
There is a weak negative correlation between FFR and diameter of stenosis assessed by angiography (r= - 0.245 p=0.038) and positive correlation between diameter of stenosis assessed by angiography and by quantitative coronary angiography (QCA) (r=0.406 p
Summary
The functional significance of coronary artery stenosis of intermediate severity is important in determining revascularization strategy in patients. By the early 1990s, fractional flow reserve (FFR) emerged as an important physiologic adjunct to coronary angiography for the assessment of intermediate lesions, directing multivessel percutaneous revascularization and guiding stent deployment. Pressure-derived fractional flow reserve (FFR) assessment has been extensively described and validated as a technique capable of identifying functionally significant [1, 2]. In centers without cardiosurgical capabilities, lack of cardiosurgeon in heart team, may cause subsequently inadequate decisions on myocardial revascularization, which make the decision process harder. Coronary artery disease is the most common cause of death in a modern world. This dictates the development a network of Catheterization laboratories without cardiosurgical capabilities
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