ABSTRACT
Objective: To evaluate the accuracy and clinical value of fractional lfow reserve (FFR) determined by CT coronary angiography (CTA) in relevant patients. Methods: A total of 43 patients treated in our hospitals from 2013-10 to 2015-10 were retrospectively studied. There were 29 (67.40%) with male gender, the average age was (60.2±10.1) years. The patients received CTA at 1 week prior coronary angiography (CAG), the interval between CTA and CAG was (5.4±1.6) days. FFR was measured by both CAG and CTA (FFRCT) in selected target vessel which was deifned as maximal diameter reduction 50% to 70%. The imaging data were recorded and compared, FFRCT was calculated. Results: 48 vessels from 43 patients were eligible for analysis as target vessels. FFRCT vas evaluated based on the gold criteria of FFR. FFRCT had the diagnostic accuracy at 83.3%, sensitivity 75.0%, speciifcity 89.3% and positive predictive value was 83.3%, negative predictive value was 83.3% respectively. FFR and FFRCT showed obvious correlation (r=0.704,P<0.001); Bland-Altman analysis presented good concordance with 95% limits of agreement for FFRCTand FFR value ranged from -0.12 to 0.16, and 95.8% of the points (46/48) fell in the 95% limit of agreement, Receiver operating characteristic curve indicated that AUC of FFRCT was 0.871 (95% CI 0.770-0.973). Conclusion: CTA could accurately assess FFR, and FFRCT might be used in guiding the treatment for patients with intermediate coronary stenosis in clinical practice.
ABSTRACT
Objective To investigate the predictive value of coagulation state on the occurrence of no-reflow phenomenon after primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods A total of 187 consecutive patients with the first AMI underwent PCI within 12h post-onset of symptom. The clinical features and angiographic findings were collected. According to the thrombolysis in myocardial infarction (TIMI) flow grade with related artery and myocardial blush grade(MBG), the patients were divided into the no-reflow group (TIMI ≤ 2, or MBG ≤ 1) and the normal reflow group. Blood samples were taken immediately on admission before coronary angiography. The levels of plasma von Willebrand factor(vWF), P-selectin(Ps) and Tissue factor(TF) were measured by enzyme-linked immunosorbent assay. Results 23.5%patients of 187 patients developed the no-reflow phenomenon. The plasma level of vWF and Ps and TF were (4 574 ± 1 677) U/L and (16.8 ± 5.1) ng/mL and (283 ± 81) ng/L in the no-reflow group, and (4 074 ± 1 063) U/L and (14.8 ± 4.2) ng/mL and (254 ± 54) ng/L in the normal group, with significant differences (P = 0.020, 0.010 and 0.007, respectively). The hypercoagulation patients in the no-reflow group were much more than patients in the normal reflow group (P = 0.003). Multivariate stepwise logistic regression analysis revealed that hypercoagulation was independent predictor of no-reflow phenomenon ( OR = 2 . 361 , 95%CI 1 . 083 ~ 5 . 148 , P = 0.031). Conclusion The high levels of plasma vWF, Ps and TF present the evidences of hypercoagulation, which might imply the development of no-reflow after PCI.