对FFR指导冠脉临界病变延迟PCI的分析
发布时间：2019-04-22 08:26
【摘要】：目的本研究通过对冠脉造影提示临界病变者,以心肌血流储备分数为指导来决定是否行介入治疗,分别随访术后1个月、6个月、12个月严重心绞痛发作情况、运动试验阳性和主要不良心血管事件的发生情况,借此来评价心肌血流储备分数在指导冠脉临界病变延迟PCI的价值。方法连续选取于2014年1月至2014年11月,诊断不稳定性心绞痛,在某医院心内科住院治疗,接受冠脉造影(CAG)检查结果示冠脉血管局限性的临界病变者,病变参考血管直径(RD)大于2.5mm,且病变的直径狭窄率(DS)介于50%至70%之间的患者94例。分成三组,CAG药物治疗组、FFR延迟治疗组、FFR介入治疗组。其中CAG药物治疗组34例,给予最优化药物治疗;FFR延迟治疗组30例是对FFR075的病变不进行PCI治疗仅给予规范的冠心病二级预防药物治疗;FFR介入治疗组30例是对FFR≤0.75的病变行PCI治疗,行PCI治疗者均植入药物涂层支架。所有患者均给予最优化的冠心病二级预防治疗。术后分别随访1个月、6个月、12个月,观察随访期间三组TG、LDL-C、HDL、LDH、CK、CKMB、c TN-I、NT-pro BNP、LVEF数值、运动实验的变化分别在术后1个月、6个月、12个月有无统计学差异;并随访三组在MACE(主要不良心脏事件)包括死亡、非致死性心肌梗死、靶血管血运重建和严重心绞痛发作情况(这里指CCS心绞痛分级Ⅲ级以上)有无差异来评价FFR指导下延迟治疗组的效果。结果所有患者均完成随访,无一人失访。结果显示三组患者在年龄、性别、吸烟史、高血压、高脂血症、糖尿病、化验指标(TG、HDL、LDH、CK、CK-MB、c TN-I、NT-pro BNP)、左室射血分数(LVEF值)、血管病变分布等临床特征方面没有统计学差异(P0.05)。FFR介入治疗组植入支架34枚(1.10±0.30),行支架植入者支架均植入成功,术后血流达TIMI3级。三组患者均给予最优化药物治疗开展冠心病二级预防。三组患者化验资料、LVEF在随访中比较无显著统计学差异(P0.05)。术后随访显示第1个月和第6个月均未发生MACE,运动实验和严重心绞痛发作情况无显著统计学差异(P0.05)。随访12个月结果示三组病例在MACE上无明显统计学意义(P0.05)。三组病例在运动试验阳性方面差异有统计学意义(P0.05),CAG药物治疗组运动试验阳性率最高,FFR延迟治疗组居中,FFR介入治疗组最低;两两比较显示:FFR介入治疗组与CAG药物治疗组间以及FFR延迟治疗组CAG药物治疗组间差异均有统计学意义(P0.05);FFR介入治疗组与FFR延迟治疗组间差异不显著(P0.05)。三组病例在严重心绞痛发作方面差异有统计学意义(P0.05),CAG药物治疗组严重心绞痛发生率最高;两两比较显示:FFR介入治疗组与CAG药物治疗组间差异最显著(P0.05);FFR延迟治疗组与FFR介入治疗组间及FFR延迟治疗组与CAG药物治疗组差异不显著。临界病变运动试验阳性者更倾向于PCI。结论1 FFR指导下延迟PCI药物治疗没有增加MACE的风险,FFR在指导冠状动脉临界病变延迟PCI安全可靠;2 FFR指导临界病变介入治疗可以降低严重心绞痛发作、运动平板阳性的发生,改善心肌缺血,提高运动耐力;FFR指导下延迟PCI治疗同样可以改善心肌缺血,提高运动耐力。
[Abstract]:Objective To study the effect of coronary angiography on the critical lesion of angina pectoris, and to determine whether to perform interventional therapy on the basis of myocardial blood flow reserve score, and follow-up of 1-month,6-month and 12-month severe angina pectoris after follow-up. The occurrence of positive and major adverse cardiovascular events in the exercise test is used to evaluate the value of myocardial blood flow reserve in the guidance of the delayed PCI of the critical coronary artery disease. Methods From January 2014 to November 2014, the patients with unstable angina pectoris were diagnosed with unstable angina pectoris. The results of coronary angiography (CAG) and coronary angiography (CAG) were used to show the critical lesions of the limitation of the coronary artery. The reference vessel diameter (RD) of the lesion was greater than 2.5 mm. And the stenosis rate (DS) of the lesion was between 50 and 70% of the patients. Three groups were divided into three groups: the CAG drug treatment group, the FFR delayed treatment group, and the FFR intervention treatment group. in which 34 of the CAG drug treatment groups were treated with an optimized drug; the FFR delayed treatment group 30 was a coronary heart disease secondary prevention drug treated only by the PCI treatment for the lesion of the FFR075; the FFR intervention treatment group 30 was a lesion line PCI treatment of the FFR group 0.75, All PCI-treated patients were implanted with a drug-coated stent. All patients were given the optimized secondary prevention of coronary heart disease. Three groups of TG, LDL-C, HDL, LDH, CK, CKMB, c-TN-I, NT-pro BNP and LVEF were followed up for 1 month,6 months and 12 months, respectively. The effectiveness of the delayed treatment group under FFR guidance was evaluated with the presence or absence of differences in the MACE (major adverse cardiac events), including death, non-fatal myocardial infarction, target vessel revascularization, and severe angina (here, CCS angina grade III or above). Results All patients were followed up and no one was lost to follow-up. The results showed that the three groups were in age, sex, smoking history, hypertension, hyperlipidemia, diabetes, test index (TG, HDL, LDH, CK, CK-MB, c TN-I, NT-pro BNP) and left ventricular ejection fraction (LVEF). There was no statistical difference in the clinical features such as the distribution of vascular lesions (P0.05). The FFR was implanted in 34 (1.10, 0.30), and the stent-implanted stents were successfully implanted and the blood flow reached the TITI3 stage. The second prevention of coronary heart disease was carried out in three groups of patients. There was no significant difference between the three groups (P0.05). There was no significant difference in the incidence of MACE, exercise and severe angina in the first and sixth months after the operation (P0.05). The results of 12-month follow-up showed no significant difference in MACE (P0.05). There was a significant difference in the positive aspects of the three groups (P0.05). The positive rate of the exercise test in the CAG group was the highest, the FFR delayed treatment group was the lowest, and the FFR was the lowest in the treatment group, and the two comparisons showed that: There was no significant difference between the treatment groups of the FFR intervention group and the CAG drug treatment group and the group of the FFR delayed treatment group (P0.05); the difference between the FFR intervention treatment group and the FFR delayed treatment group was not significant (P0.05). There was a significant difference in the incidence of severe angina (P0.05). The incidence of severe angina in the treatment group was the highest in the treatment group of CAG. The two comparisons showed that the difference between the two groups was the most significant (P0.05). The difference between the FFR-delayed treatment group and the FFR-delayed treatment group and the FFR-delayed treatment group was not significant. The patients with critical lesion movement were more prone to PCI. Conclusion 1 FFR-guided PCI drug therapy did not increase the risk of MACE. FFR was safe and reliable to guide the delayed PCI of the coronary critical lesion. FFR-guided interventional therapy could reduce the onset of severe angina, the occurrence of positive plate positive, and improve the myocardial ischemia. Improve that endurance of exercise; the delayed PCI treatment under the guidance of FFR can also improve the myocardial ischemia and improve the exercise endurance.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R54
本文编号：2462677
[Abstract]:Objective To study the effect of coronary angiography on the critical lesion of angina pectoris, and to determine whether to perform interventional therapy on the basis of myocardial blood flow reserve score, and follow-up of 1-month,6-month and 12-month severe angina pectoris after follow-up. The occurrence of positive and major adverse cardiovascular events in the exercise test is used to evaluate the value of myocardial blood flow reserve in the guidance of the delayed PCI of the critical coronary artery disease. Methods From January 2014 to November 2014, the patients with unstable angina pectoris were diagnosed with unstable angina pectoris. The results of coronary angiography (CAG) and coronary angiography (CAG) were used to show the critical lesions of the limitation of the coronary artery. The reference vessel diameter (RD) of the lesion was greater than 2.5 mm. And the stenosis rate (DS) of the lesion was between 50 and 70% of the patients. Three groups were divided into three groups: the CAG drug treatment group, the FFR delayed treatment group, and the FFR intervention treatment group. in which 34 of the CAG drug treatment groups were treated with an optimized drug; the FFR delayed treatment group 30 was a coronary heart disease secondary prevention drug treated only by the PCI treatment for the lesion of the FFR075; the FFR intervention treatment group 30 was a lesion line PCI treatment of the FFR group 0.75, All PCI-treated patients were implanted with a drug-coated stent. All patients were given the optimized secondary prevention of coronary heart disease. Three groups of TG, LDL-C, HDL, LDH, CK, CKMB, c-TN-I, NT-pro BNP and LVEF were followed up for 1 month,6 months and 12 months, respectively. The effectiveness of the delayed treatment group under FFR guidance was evaluated with the presence or absence of differences in the MACE (major adverse cardiac events), including death, non-fatal myocardial infarction, target vessel revascularization, and severe angina (here, CCS angina grade III or above). Results All patients were followed up and no one was lost to follow-up. The results showed that the three groups were in age, sex, smoking history, hypertension, hyperlipidemia, diabetes, test index (TG, HDL, LDH, CK, CK-MB, c TN-I, NT-pro BNP) and left ventricular ejection fraction (LVEF). There was no statistical difference in the clinical features such as the distribution of vascular lesions (P0.05). The FFR was implanted in 34 (1.10, 0.30), and the stent-implanted stents were successfully implanted and the blood flow reached the TITI3 stage. The second prevention of coronary heart disease was carried out in three groups of patients. There was no significant difference between the three groups (P0.05). There was no significant difference in the incidence of MACE, exercise and severe angina in the first and sixth months after the operation (P0.05). The results of 12-month follow-up showed no significant difference in MACE (P0.05). There was a significant difference in the positive aspects of the three groups (P0.05). The positive rate of the exercise test in the CAG group was the highest, the FFR delayed treatment group was the lowest, and the FFR was the lowest in the treatment group, and the two comparisons showed that: There was no significant difference between the treatment groups of the FFR intervention group and the CAG drug treatment group and the group of the FFR delayed treatment group (P0.05); the difference between the FFR intervention treatment group and the FFR delayed treatment group was not significant (P0.05). There was a significant difference in the incidence of severe angina (P0.05). The incidence of severe angina in the treatment group was the highest in the treatment group of CAG. The two comparisons showed that the difference between the two groups was the most significant (P0.05). The difference between the FFR-delayed treatment group and the FFR-delayed treatment group and the FFR-delayed treatment group was not significant. The patients with critical lesion movement were more prone to PCI. Conclusion 1 FFR-guided PCI drug therapy did not increase the risk of MACE. FFR was safe and reliable to guide the delayed PCI of the coronary critical lesion. FFR-guided interventional therapy could reduce the onset of severe angina, the occurrence of positive plate positive, and improve the myocardial ischemia. Improve that endurance of exercise; the delayed PCI treatment under the guidance of FFR can also improve the myocardial ischemia and improve the exercise endurance.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R54
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