Angiografic Marginally Important Coronary Stenosis - Implementation or Postponementof Intervention Based on Myocardial Fractional Flow Reserve
Abstract
When evaluating angiographically marginal coronary stenoses (i.e. 40-70% reduction of the diameter of the arterial lumen) it is under certain conditions difficult to decide on their actual functional impact. Assessment of the fractional flow reserve (FFR) is a simple method based on assessment of intracoronary pressures during pharmacologically induced hyperaemia.
For the severity of stenosis according to previous studies the liminal values is FFR lower than 0.75; furthermore it was proved that intervention of angiographically marginal stenoses with FFR values of 0.75 or more can be safely postponed. OBJECTIVE: Test the safety of FFR examination and take in a group of patients with marginally severe stenosis further steps according to results of FFR assessment.
MATERIAL AND METHODS: During the period from January to Juky 2000 FFR assessments were made in a total of 34 patients (11 women, 23 men, mean age 62 +/- 12 years) who suffered from marginal stenosis of some coronary vessel. The FFR examination took place under pharmacologically induced hyperaemia after intracoronary adenosine administration.
RESULTS: Measurements were made in a total of 41 stenoses. Only in two a value lower than 0.75 was found.
In these patients coronary intervention was implemented; intervention was also made in two patients on account of technical problems and inconsistent results of FFR measurements. A FFR value of 0.75 or less was found in 37 stenoses (90%) and intervention was therefore postponed.
Examination and the immediate subsequent course were without complications. CONCLUSION: According to initial experience FFR examination is a safe, simple and easily reproducible method.
Based on the results of assessment and knowledge of the accomplished studies in the group of marginally significant stenoses in a great proportion of patients coronary intervention was postponed.