血流储备分数在评估冠状动脉病变及指导介入治疗的荟萃分析  

Meta-analysis of fractional flow reserve for evaluating coronary lesions and guiding treatment

作　　者：刁佳宇[1] 叶红华[2] 陈晓敏[2] 

机构地区：[1]西安交通大学医学院附属红会医院内科,西安710054 [2]宁波市第一医院心内科

出　　处：《临床心血管病杂志》2012年第10期787-793,共7页Journal of Clinical Cardiology

摘　　要：目的:汇总分析与冠状动脉(冠脉)造影定量分析(QCA)及其他检查方法相比,血流储备分数(FFR)在冠脉病变的评估与指导经皮冠脉介入治疗(PCI)方面是否一致。方法:系统检索1995-01-2011-06关于FFR与QCA和(或)其他检查方法对冠脉病变评估和指导PCI疗效比较的相关英文文献。根据纳入与排除标准收集相关结果和数据,通过Meta分析方法,加权计算与QCA及其他检查方法相比FFR评估冠脉病变的敏感率、特异率,绘制SROC曲线,并系统比较FFR与QCA指导PCI术后的主要不良心脏事件(MACE)发生率。结果:有41篇文献纳入研究,共包括4 677例患者,7 586处冠脉病变。FFR(0.75标准)与QCA相比的敏感率与特异率分别为0.76(95%CI0.73,0.80)和0.66(95%CI0.63,0.68);对评估中度狭窄病变(30%～70%)敏感率、特异率分别为0.60(95%CI0.56,0.65)和0.63(95%CI0.59,0.66)。与除QCA外的其他检查方法相比,FFR(0.75标准)的敏感率与特异率分别为0.72(95%CI 0.67,0.76)和0.79(95%CI 0.75,0.82)。与QCA相比,FFR指导PCI术后随访MACE发生率更低(10%:17%),OR值为0.72(95%CI0.54,0.95)。结论:FFR与QCA对冠脉病变评估的一致性不高,特别是评估中度狭窄病变时;其他影像学检查与FFR的一致性一般。FFR指导PCI治疗的临床结果并不比QCA逊色。Objective：To provide cumulative data compared the concordances of fractional flow reserve （FFR） with quantitative coronary angiography （QCA） and other examination methods for evaluating coronary artery dis- ease and guiding PCI treatment. Method：A comprehensive search for all relevant articles published in English from January 1995 to June 2011 was conducted. Two reviewers evaluated each study to determine whether it was eligi- ble for inclusion and collected the data of interest. Meta-analytic results of FFR against with QCA and （or） other examination methods in evaluating coronary lesions were performed for the overall sensitivity and specificity. SROC curves were also estimated. Comparing the MACE rates in PCI guided by FFR or QCA. Result：Forty-one studies with 4 677 patients and 7 586 lesions were included. FFR （0.75 cutoff） had a sensitivity of 0.76 （95%CI 0.73 to 0. 80） and specificity of 0.66 （95%CI 0.63 to 0. 68） against QCA. The sensitivity and specificity were 0.60 （95%CI 0.56 to 0.65） and 0.63 （95%CI 0. 59 to 0.66） of FFR against QCA for lesions with diameter ste- nosis 30% to 70%. Compared with FFR （0.75 cutoff）, other examination methods had sensitivity of 0.72 （95% CI O. 67 to 0.76） and specificity of 0.79 （95%CI 0.75 to 0.82）. The overall MACE rates was lower in the FFR guided PCI group （FFR-PCI） than in the QCA guided PCI group （QCA-PCI） （10% vs 17%）, and the OR was 0.72 （95 % CI O. 54 to 0.95）. Conclusion：The concordance of FFR against QCA is not so good, especially for 30 % --70 % stenosis lesions. FFR showes modest concordance with other examination methods. FFR-PCI is not inferi- or to QCA-PCI in clinical follow-up outcomes.

关 键 词：冠心病 血流储备分数 冠状动脉造影定量分析 冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]