血流储备分数应用于PCI治疗对心血管不良事件的影响

发布时间：2019-03-28 13:55

【摘要】：目的：冠脉血流储备分数(Fractional Flow Reserve,FFR)是评估冠状动脉血管功能性狭窄的参考指标。本研究将通过对比传统冠脉造影指导下PCI治疗术后患者与血流储备分数指导下PCI治疗术后患者的预后,探讨FFR应用于PCI治疗对患者不良心血管事件的影响。方法：入选对象为2012年10月至2014年4月在昆明医科大学第二附属医院心内科住院的第一诊断为冠心病慢性稳定型心绞痛的患者,连续入选110例冠状动脉造影提示单支血管局限性病变、且病变的直径狭窄介于70%至85%之间的患者,病变参考血管直径大于2.5mm。将入选病人分为两组：冠脉造影术后,行PCI治疗,未行FFR评估的患者为PCI组(n=89)；行冠脉造影显示临界病变后行FFR评估的患者,为FFR组(n=21)；将第二组进一步分为两个亚组,若患者行FFR评估后进一步接受支架植入治疗,则为FFR阳性组(FFR-Y组,n=11),若患者行FFR后未进一步行支架植入治疗,则为FFR阴性组(FFR-N组,n=10)。临床事件将在随访12个月后进行分组对比。结果：在PCI组与FFR组的对比中,PCI组MACE发生1例,为随访期不明原因死亡,发生率1.12% vs.FFR组0.00%；PCI组院内终点事件发生4例,其中3例为靶血管相关导联ST段压低,1例T波倒置,发生率4.49% vs.0.00%；PCI组随访期心血管事件发生14例,其中再发心绞痛7例,门诊Holter呈现靶血管相关导联ST-T改变7例,FFR组再发心绞痛1例,发生率15.73%vs.4.76%。FFR-Y组在12个月随访期满无MACE发生,无院内／随访期终点事件发生。但上述差异无统计学意义,P0.05。FFR组与PCI组相比,FFR组院内终点事件、院外终点事件发生率均低于PCI组,在PCI组分别与FFR-Y及FFR-N两个亚组的对比中,FFR-Y组及FFR-N组院内终点事件、院外终点事件发生率均低于PCI组。结论：与传统冠脉造影指导下进行PCI治疗比较,FFR应用于临界病变PCI治疗有降低心血管不良事件发生率的趋势。
[Abstract]:Objective: coronary flow reserve fraction (Fractional Flow Reserve,FFR) is a reference index for evaluating functional stenosis of coronary artery. This study will compare the prognosis of patients after PCI under the guidance of traditional coronary angiography and PCI under the guidance of blood flow reserve fraction, and explore the effect of FFR on adverse cardiovascular events in patients treated with PCI. Methods: from October 2012 to April 2014, the patients who were first diagnosed as chronic stable angina pectoris of coronary heart disease in the Department of Cardiology, the second affiliated Hospital of Kunming Medical University, were enrolled in the study. In 110 consecutive patients with localized lesions of single vessel, the diameter of the lesion was between 70% and 85%, and the reference diameter of the lesion was more than 2.5 mm. The patients were divided into two groups: PCI group (n = 89) without PCI after coronary angiography, FFR group (n = 21), and FFR group (n = 21). The second group was further divided into two subgroups. If the patients received further stent implantation after FFR evaluation, the patients were FFR positive group (FFR-Y group, n = 11). If the patients underwent FFR, no further stent implantation therapy was performed. FFR negative group (FFR-N group, n = 10). Clinical events will be compared in groups after 12 months of follow-up. Results: in the comparison between PCI group and FFR group, one case of MACE occurred in PCI group, which was unexplained death during follow-up period. The incidence of MACE was 1.12% in vs.FFR group. In PCI group, there were 4 cases of in-hospital end-point events, including 3 cases of ST segment depression in target vessel-related leads and 1 case of T-wave inversion. The incidence of T-wave inversion was 4.49% vs.0.00%;. In PCI group, 14 cases of cardiovascular events occurred during follow-up period, including 7 cases of recurrent angina pectoris, 7 cases of target vessel-related lead ST-T changes in out-patient Holter, and 1 case of recurrent angina pectoris in FFR group. In the 15.73%vs.4.76%.FFR-Y group, no MACE occurred at the end of the follow-up period of 12 months, and no in-hospital / follow-up end-point events occurred. But there was no significant difference between P0.05.FFR group and PCI group. Compared with PCI group, the incidence of in-hospital end-point event and out-of-hospital end-point event in FFR group was lower than that in PCI group, in PCI group compared with FFR-Y and FFR-N subgroups, respectively. The incidence of in-hospital end-point events and out-of-hospital end-point events in FFR-Y and FFR-N groups were lower than those in PCI group. Conclusion: compared with PCI under the guidance of traditional coronary angiography, the use of FFR in the treatment of critical lesion PCI has a tendency to reduce the incidence of cardiovascular adverse events.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

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