在病例介绍之后，李建平教授与Emanuele Barbato教授就FFR在急性心梗患者当中的应用进行了探讨。
李建平教授探究道：对于病例1中的急性心梗患者，Emanuele Barbato教授在急诊PCI两日后即行功能学评估，而中国的专家共识2,3则推荐一周后再做功能性评估，想了解Emanuele Barbato 教授对此如何看待？
（ 参 考 原 文 ： Prof. Barbato, thank you very much for your nice presentation. Firstly, you presented an AMI patient, you did primary PCI for circumflex, and then two days later you performed functional assessment. But it’s suggested and recommended for AMI patient, functional assessment should be performed one week after heart attack. So what is your opinion for this ?）
而Emanuele Barbato教授认为能即刻评估还是需要择期一周以后评估，问题的关键在于患者血流动力学状态是否稳定：针对ACS中STEMI合并多支血管病变的患者群体，已经存在随机对照临床研 究4,5。其高质量的研究结果数据较好地表明，对血流动力学状态稳定下的患者，在急诊PCI时，对其 非罪犯病变进行介入式功能学检查是可行的。当然，在血流动力学不稳定情况下，譬如存在心源性休 克等情况，不建议采用介入式功能学评估。Emanuele Barbato教授也坦诚道，因病例1中的患者急诊PCI时主刀者并非是他，故其含功能评估的择期手术安排在两日后。但若该患者急诊PCI由他来主 刀，当时一并进行（非罪犯病变的）功能学评估也没有问题。
（ 参考原文：Thank you very much Prof. Li for your question. Actually we have now quality data also on the setting of ACS patient, STEMI patients and multivessel disease. There are randomized trials nicely demonstrating that invasive functional assessment of non-culprit stenosis, in a patient in stable hemodynamic conditions are equally reliable, whether you do it at the location of the same primary PCI session or within one week. So basically there is not much of difference in the true reliability of the FFR values, in the non-culprit stenosis. Of course the situation is completely different if the patient is hemodynamically unstable, in cardiogenic shock, or something like this. That will not be advisable to do invasive functional assessment in non-culprit stenosis. But other than that, I think quite comfortable to do this FFR evaluation, also at the location of the primary PCI. It was not the case of my patient because the patient was not done by me acutely, so I added it to my table two days later. But honestly, I would have done it also acutely without any problems .）
[1] 罂粟碱：由于其不良反应（尤其是静脉注射时）含严重室性心律失常乃至室颤，我国2016年的《冠状动脉血流储备分数临床应用专家共识》和2019年的《冠状动脉血流储备分数测定技术临床路径专家共识》FFR测量中推荐使用的，为罂粟碱以外的血管扩张药物。
参考文献
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3. 《中国冠状动脉血流储备分数测定技术临床路径专家共识》专家组. 中国冠状动脉血流储备分数测定技术临床路径专家共识. 《中国介入心脏病学杂志》. 2019;27(3):121-133.
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