血流储备分数对冠状动脉分叉病变PCI治疗策略的影响  

Effects of fractional flow reserve on therapeutic strategies of percutaneous coronary intervention for coronary bifurcation lesions

作　　者：杨慎先[1] 杜梅花[1] 王枫岭[1] 蔡海羽 周向东[1] 

机构地区：[1]河南省胸科医院心内科,河南省郑州市450003

出　　处：《中国心血管病研究》2015年第2期141-144,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的 评价血流储备分数（FFR）用于指导经皮冠状动脉介入（PCI）治疗分叉病变的临床价值.方法 选取2012年1月至2014年1月在我院行冠状动脉造影显示分叉病变、预计单支架植入（Crossover）、主支植入支架后发现对分支开口有不同程度影响的患者96例,其中男性68例、女性28例,年龄40～76（60±8）岁.随机分为2组：FFR指导的PCI组（FFR组）50例,冠状动脉造影（CAG）指导的PCI组（对照组）46例.将FFR≤0.75作为FFR组PCI的标准,将CAG测量的血管直径狭窄率（DS）≥75％作为对照组PCI的标准.观察手术即刻指标及预后疗效.结果 FFR组分支植入支架例数较对照组明显减少（18％比37％,p=0.037）,手术时间明显缩短[（1.5±0.4）h比（2.0±0.5）h,P=0.001].FFR组无手术相关并发症,对照组有1例夹层、1例慢血流和1例支架植入不成功.FFR组FFR≤0.75且DS＜75％的例数占6％（3/50）,FFR＞0.75且DS≥75％的例数占32％（16/50）.随访（1.3±0.5）年,两组不良心血管事件（MACE）（6％比13％,P＞0.05）和再发心绞痛（10.0％比15.2％,P＞0.05）比较未见统计学差异.结论 FFR在指导分叉病变的PCI治疗上优于CAG,可减少不必要的支架植入及并发症.Objective To evaluate the clinical value of fractional flow reserve（FFR ）-guided percutaneous coronary intervention （PCI） treatment on coronary bifurcation lesions. Methods 96 patients aged 40-76 （60±8） including 68 males and 28 females were selected, who were detected by coronary angiography （CAG） and found with some bifurcation lesions and different effects on side branch ostium after single main vessel stenting from January 2012 to January 2014 in our hospital. They were randomly divided into two groups, which were FFR-guided PCI group （FFR group, 50 patients） and GAG-guided PCI group （control group, 46 patients）. FFR≤0.75 was used as PCI criterion in FFR group and the diameter stenosis （DS）≥75% by CAG was used in control group. At last, instantly indicators, prognosis and curative effect were observed. Results Compared with control group, the number of branch stent placement cases decreased significantly （18% vs 37%, P=0.037） and the operation time was shortened obviously [（1.5±0.4）h vs （2.0±0.5）h, P=0.001] in FFR group. At the meantime, one case of coronary artery dissection, one case of slow coronary flow and one case of unsuccessful stent implantations occurred in control group, while no operative complications took place in FFR group. What＇s more, in FFR group, cases of FFR≤0.75 with DS〈75% accounted for 6%（3/50） and cases of FFR〉0.75 with DS≥75% accounted for 32% （16/50）. There was no significant difference of major adverse cardiac events （MACE） （6% vs 13%, P〉0.05） or refractory angina pectoris （10.0% vs 15.2%, P〉0.05） in the two groups through （1.3±0.5）years follow-up. Conclusion FFR is superior to CAG in guiding PCI treatment on coronary bifurcation lesions. It could reduce unnecessary stent implantations and decrease operative complications.

关 键 词：血流储备分数 冠状动脉造影 分叉病变 经皮冠状动脉介入治疗 治疗策略 

分 类 号：R541.4[医药卫生—心血管疾病]