心肌血流储备分数指导下药物治疗冠状动脉临界病变患者的远期疗效  

Viablility of myocardial fractional flow reserve-guided medical treatment of an intermediate coronary stenosis

作　　者：刘华云[1] 何蕾[1] 鄢华[1] 汪敏[1] 宋丹[1] 苏晞[1] 

机构地区：[1]武汉亚洲心脏病医院心内科,430022

出　　处：《中国介入心脏病学杂志》2013年第4期220-222,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的研究心肌血流储备分数(FFR)指导下药物治疗冠状动脉临界病变患者的安全性。方法 2010年4月至2011年9月武汉亚洲心脏病医院介入中心行冠状动脉造影提示临界病变同时行冠状动脉内压力导丝测定FFR≥0.8的连续15例患者,规范冠心病二级预防药物治疗。随访≥1年,包括主要不良事件(包括死亡、心肌梗死、再次靶病变血运重建术、卒中)及再发心绞痛、再次住院、出血发生情况。结果 15例患者平均(61±7.49)岁。其中男性7例(46.7%),冠状动脉造影病变平均(1.2±0.5)支。15例患者冠状动脉造影提示19处临界病变:左前降支15处、回旋支3处,右冠状动脉1处;其中单支病变者11例(73.3%),双支病变者4例(26.7%),均合并前降支病变;FFRmyo均值(0.88±0.06)。15例患者平均随访(23.6±5.67)个月,其中1例(6.7%)失访。2例(13.3%)不稳定型心绞痛患者随访期间出现心绞痛,症状较前无明显加重,含服硝酸甘油可缓解,余心肌梗死、再次靶病变血运重建术、卒中、全因死亡、再次住院率、出血等不良事件无发生。对入选患者心绞痛发生情况采用Kaplan-Meier法做生存分析,FFR术后平均再发心绞痛时间为术后(29.12±0.67)个月。结论初步验证了FFR指导下药物治疗冠状动脉临界病变患者是可行的。Objective To investigate the appropriateness of myocardial fractional flow reserve （FFR）-guided medical treatment of an intermediate coronary stenosis. Methods Prospective clinical data were collected from consecutive 15 patients with intermediate coronary stenosis diagnosed by coronary angiography and the FFR was measured 〉 or = 0. 8 when received medical treatment in our center. The mean length of follow-up was 23.6±5.67 months （ range, 14 - 30 months ）. Clinical outcomes of major adverse cardiac events （cardiac death, acute myocardial infraction, late revascularization of the index lesion）, rates of recurrent angina and bleeding were taken into analysis. Total 19 coronary lesions were identified in all the 15 patients including 15 lesions at LAD, 3 lesions at LCX and 1 lesion at RCA. Results The mean age was （61±7.49） years, complete follow-up was obtained in 93. 3% of the patients. Only 2 patients had angina peetoris （ 13. 3% ）. The mean time of angina occurred after FFR was 29. 12±0. 67 months. Conclusions Optimizing medical treatment of an intermediate coronary stenosis based on FFR 〉/= 0. 8 is viable.

关 键 词：心肌血流储备分数 冠状动脉临界病变 药物治疗 

分 类 号：R541.4[医药卫生—心血管疾病]