血管内超声与血流储备分数在冠状动脉多支病变中的应用比较  

Intravascular ultrasound and fractional flow reserve in patients with multivessel coronary artery disease

作　　者：惠波[1] 邵一兵[1] 刘玉昊[1] 许文亮[1] HUI Bo;SHAO Yi-bing;LIU Yu-hao;XU Wen-liang(Department of Cardiology,East District of Qingdao Municipal Hospital,Qingdao,Shandong 266071,China)

机构地区：[1]青岛市市立医院东院区心内科,山东青岛266071

出　　处：《中国临床研究》2020年第5期646-649,共4页Chinese Journal of Clinical Research

摘　　要：目的评估应用血管内超声(IVUS)与血流储备分数(FFR)对冠脉介入治疗(PCI)的冠状动脉(冠脉)多支病变患者指导作用及临床疗效。方法选取2012年1月至2014年4月有冠脉多支病变的冠心病患者54例,随机分为三组。FFR指导组17例,共41处病变,行FFR测定(其中FFR≤0.80的冠脉狭窄处行支架植入术);IVUS指导组19例,共43处病变,行IVUS检查(其中冠脉病变处最小管腔面积<4 mm^2行支架植入术);CAG指导组18例,共40处病变,不作FFR测定和IVUS检查(根据CAG结果,狭窄>70%的病变处常规行PCI支架植入)。比较三组支架植入数目、1年后胸痛发作情况及主要心血管事件发生率。结果FFR指导组支架植入数目[(1.71±0.47)个]分别少于CAG指导组[(2.33±0.49)个,P<0.01]和IVUS组[(2.00±0.33)个,P<0.05];而IVUS指导组支架植入数目少于CAG指导组(P<0.05)。三组患者均获随访1年,心绞痛与主要心血管事件发生率比较差异无统计学意义(P>0.05)。结论IVUS与FFR均可应用于冠脉多支病变患者PCI治疗的指导,FFR可降低支架植入数目,使血运重建率明显降低。Obstract To evaluate the application of intravascular ultrasound(IVUS) and fractional flow reserve(FFR) on percutaneous coronary intervention(PCI) and the clinical effects in patients with multivessel coronary artery disease.Methods Fifty-four patients with multivessel coronary artery disease from January 2012 to April 2014 were randomly divided into FFR group(n=17),IVUS group(n=19) and coronary arteriography(CAG) group(n=18).In FFR group,intracoronary stent implantation was performed for coronary stenosis by FFR ≤0.80 in 41 lesions.In IVUS group,stents were placed in 43 coronary lesions with minimal lumen cross-sectional area(CSA) <4 mm^2.In CAG group,routine stent implantation was performed in 40 lesions with more than 70% stenosis according to the results of CAG.The number of stents implanted,the incidences of chest pain and major cardiovascular events(MACE) one year later were compared among the three groups.Results The number of stent implanted in FFR group(1.71±0.47)was significantly less than that in CAG group(2.33±0.49,P<0.01)and in IVUS group(2.00±0.33,P=0.05),respectively,and the number of stent was statistically less in IVUS group than that in CAG group(P<0.05).There were no significant differences in the incidences of MACE and angina pectoris during one-year follow-up period among three groups(P>0.05).Couclusion Both IVUS and FFR can be used to guide PCI in patients with multi vessel coronary disease,however,FFR-guided PCI can reduce the number of stent and the rate of coronary revascularization.

关 键 词：冠心病 冠状动脉多支病变 血管内超声检查 血流储备分数 冠脉介入治疗 支架植入 血运重建 

分 类 号：R543.3[医药卫生—心血管疾病]