血流储备分数与冠状动脉造影指导对急性冠状动脉综合征患者中度狭窄病变药物治疗预后的影响  

A comparison of the outcome of therapy between fractional flow reserve guided- versus coronary angiography guided-strategy in acute coronary syndrome patients with moderate coronary lesions

作　　者：宋荟芬[1] 李红[1] 李响[1] 杨铎[1] 韩静[1] 贾若飞[1] 孟帅[1] 金泽宁[1] 

机构地区：[1]首都医科大学附属北京安贞医院33病房,100029

出　　处：《中华内科杂志》2016年第7期520-524,共5页Chinese Journal of Internal Medicine

摘　　要：目的分析血流储备分数（FFR）与冠状动脉（冠脉）造影（CAG）指导对急性冠脉综合征（ACS）患者冠脉中度狭窄病变药物治疗临床预后的影响。方法回顾性分析2014年7月1日至2015年7月30日在首都医科大学附属北京安贞医院行CAG显示为冠脉中度狭窄病变且行FFR检查FFR值〉0．8的ACS患者98例（FFR组），仅接受药物治疗，及同时期仅行CAG的ACS患者冠脉中度狭窄病变仅接受药物治疗病例151例（CAG组）；比较两组平均10个月随访期间的主要心血管不良事件（MACE，包括死亡、靶血管血运重建、非致死性心肌梗死）。结果FFR组和CAG组发生主要终点事件共计29例，FFR组6例（6．5％），CAG组23例（16．2％），P=0．036。两组靶血管血运重建率5．4％比14．8％，P=0．045；非致死性心肌梗死发生率2．2％比3．5％，P=0．242；两组均无死亡病例。FFR组他汀类药物使用比例（P=0．033）及住院费用（P=0．001）显著高于CAG指导组。结论在ACS患者中，FFR结合CAG指导的药物治疗较单纯CAG指导的药物治疗可显著减少靶血管血运重建及MACE事件发生率，但伴随着住院费用增加。Objective To compare the outcomes between coronary angiography （CAG） guided- and fractional flow reserve （FFR） guided-strategy in acute coronary syndrome （ACS） patients with moderate lesions. Methods Totally, 249 ACS subjects with moderate lesions examined by CAG in Beijing Anzhen Hospital from July 1,2014 to July 30,2015 were included in the present analysis. Among them, 98 patients were further examined by FFR and 151 were not. All the patients were treated with medication either guided by CAG or by FFR. Subjects were followed up for an average of 10 months. The end points included death, nonfatal myocardial infarction （MI）, target vessel revascularization （TVR）, and hospitalization costs. Major adverse cardiac events （MACE） were defined as death, nonfatal MI, and TVR. Results At the end of follow-up, 29 patients had MACE with 6 cases （6. 5% ） in the FFR-guided group, and 23 cases （16. 2% ） in the CAG-guided group （ P = 0. 036）. Patients treated with FFR-guided strategy had significantly lower rate of TVR than those treated with CAG-guided strategy （5.4% vs 14. 8%, P = 0. 045 ）. No statistical difference was observed in nonfatal MI （2.2% vs 3.5%, P =0.242） between the two groups, and no cardiac death occurred in the two groups. However, the rate of patients treated with stains （P = 0. 033） and the hospitalization costs （P = 0. 001 ） were significantly increased in the FFR-guided group. Conclusions FFR-guided strategy for patients with ACS resuhs in lower TVR and MACE, but higher cost when compared with CAG-guided strategy.

关 键 词：冠状血管造影术 血流储备分数 心肌 急性冠状动脉综合征 血运重建 

分 类 号：R541.4[医药卫生—心血管疾病]