The difference between functional and imaging strategies in coronary heart disease intervention therapy

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According to reports, the number of global coronary atherosclerotic heart disease (coronary heart disease) has exceeded 180 million, and the number of coronary heart disease in my country exceeds 11 million. Coronary arterial (coronary) intervention treatment is one of the most effective ways to treat coronary heart disease, and its curative effect directly affects the quality of life and prognosis of patients with ten million coronary heart disease. The most basic intervention therapy is based on coronary film, and the Fractional Flow Reserve (FFR) and intravascular ultrasound (IVUS) are high -level creative technologies for routine radical examination. The former is the most widely used coronary functional evaluation technology, while the latter is the most widely used coronary imaging evaluation technology. A large number of studies have confirmed that the intervention therapy of the two technical guidance has obvious advantages compared to simplicity of angiography guidance. But even so, FFR and IVUS have their own advantages and disadvantages. FFR has absolute advantages in selecting myocardial ischemia patients and deciding whether to intervene. IVUS has obvious guiding significance in the process of reconstruction of vascular reconstruction and its optimization. However, as a strategy to guide the entire intervention treatment, the two technologies are unclear. In addition, it is difficult to use two technologies at the same time in many cases, but there is no research on the head opposite of the two technologies. Therefore, the direct contrast between the two is of great significance for coronary heart disease intervention therapy.

Recently, the team of Professor Wang Jianan of Zhejiang University and Professor Bon-Kwon KOO of Seoul University and 16 medical centers in China and foreign countries published on New England Journal of Medicine. The study compared the guidance value of FFR and IVUS in interventional therapy, and aims to make up for the guide gap and give patients more accurate and more reasonable treatment.

This is a forward -looking, random, open label test, and a total of 1682 patients with a compatible with medium -sized stenosis. Randomly divided into FFR treatment strategy group (interventional therapy indicator FFR ≤ 0.80) and IVUS treatment strategy group (interventional therapy indicator is minimum lumen area [MLA] ≤3mm2 or 3mm2 <[MLA] ≤4mm2 and spot load> 70%). The main ending is 24 months of death, myocardial infarction, and the complex end of the reconstruction of blood transportation again.

The results showed that the FFR group was not inferior to the IVUS group (8.1% vs. 8.5%, non -inferiority P = 0.01) at the IVUS group. However, the proportion of patients in the FFR group was about 21%lower than the IVUS group (44.4%vs. 65.3%).

Flavour's research once again confirms that even with the IVUS guidance strategy, the FFR can still effectively reduce the reconstruction of blood transportation and reduce the number of brackets. Today, with the increasing increase in coronary heart disease and relatively scarce medical resources, this result has significant health economics significance.

In addition, compared to FFR's clear intervention therapy, IVUS's interventional therapy decision -making ability is recognized as its "shortcomings". The interventional treatment indication of IVUS used in this institute considers not only considering the narrow lumen and taking into account the load of the plaques. As a result, the guidance value of the FFR ≤ 0.80 is obtained. This result is expected to become an important step in changing the current status of IVUS.

For the first time, the study compared the guidance value of the two different dimensions of FFR and IVUS in the critical lesions of the coronary arteries, and opened the comparison research of functional evaluation methods and intra -cavity image tools, which has an epoch -making pioneering significance. At the moment, cardiac doctors and cardiac tube rooms with only one of the two equipment of FFR or IVUS have direct practical significance.

Professor Hu Xinyang from the Second Affiliated Hospital of Zhejiang University Medical College is the first author of the paper, and Professor Wang Jianan is the main communication author of the paper.

Original link:

https://www.nejm.org/doi/full/1056/nejmoa2201546

references

1. KOO B-K, Hu X, Kang J, ZHANG J, Jiang J, Hahn J-Y, NAM C-W, DOH J-H, Lee B-K, Kim W, Huang J, JIANG F, ZHON P, TANG L, Jiang W, Jiang WMedicine. 2022; 57: 779-789. If you want to know more exciting content, come and pay attention to bioart biological art

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