定量血流分数在老年急性ST段抬高心肌梗死非罪犯血管病变中的应用评价  

Evaluation of quantitative flow ratio in non⁃culprit lesion in elderly patients with acute ST⁃segment elevation myocardial infarction

作　　者：干倩 翟馨蓉 韩文正 陈阳 曲新凯 关韶峰 Gan Qian;Zhai Xinrong;Han Wenzheng;Chen Yang;Qu Xinkai;Guan Shaofeng(Department of Cardiology,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China)

机构地区：[1]复旦大学附属华东医院心内科,上海200040

出　　处：《老年医学与保健》2023年第2期210-214,共5页Geriatrics & Health Care

基　　金：上海市卫生和计划生育委员会科技发展基金项目(201840278,202040298)。

摘　　要：目的 评价定量血流分数(quantitative flow ratio, QFR)指导老年ST段抬高急性心肌梗死(acute ST segment elevation myocardial infarction, STEMI)非罪犯血管病变(non-culprit lesion, NCL)血运重建的价值。方法 前瞻性入选STEMI合并多支病变(multivessel disease, MVD)老年患者,行急诊经皮冠脉介入治疗(percutaneous coronary intervention, PCI)后,将相关影像离线传输至QFR工作站进行分析,并根据急性期QFR结果决定是否择期对NCL进行血运重建,QFR≤0.80则处理NCL, QFR>0.80则进行强化药物治疗,择期干预时造影后再次行QFR测定,比较NCL急性期和择期造影时QFR结果的差异,所有入选患者通过电话和门诊随访,记录所有患者在术后1年时的主要心脏不良事件(major adverse cardiac events, MACE),包括:全因死亡,再发心梗,靶病变再次血运重建。结果 108例患者入选并完成了离线QFR检查,30例QFR≤0.80的患者的32支NCL血管行择期PCI治疗,75例QFR>0.80的患者接受强化药物治疗。对接受择期PCI的30例患者的32个病变血管,在择期介入时QFR检查结果和急诊时测得的QFR结果高度相关和一致(0.73±0.08)vs(0.73±0.09),r=0.94,平均差值(0.01±0.06)。以QFR≤0.80为标准,以定量冠脉造影(quantitative coronary angiography, QCA)直径狭窄≥70%来确定病变的功能性意义,其准确性仅75.9%。入选患者中107例(99.1%)完成了1年临床随访,QFR≤0.80患者中,1例患者(3.0%)发生非ST段抬高心肌梗死,1例患者(3.0%)行靶血管再次血运重建,QFR>0.80患者中,2例(1.3%)患者行靶血管再次血运重建。结论 QFR在急性心肌梗死急性期评价NCL病变的功能性意义是可行且准确的,QFR≤0.80来决定NCL是否干预是合理且安全的指标。在有限选择的人群当中,QFR可能成为日常指导老年急性ST段抬高心肌梗死非罪犯病变血运重建的安全可靠的工具。Objective To evaluate the value of quantitative flow ratio(QFR)in guiding blood flow reconstruction in non⁃culprit lesion(NCL)in elderly patients with acute ST⁃segment elevation myocardial infarction(STEMI).Methods Pa⁃tients with STEMI and multivessel disease(MVD)were prospectively enrolled.After emergency percutaneous coronary inter⁃vention(PCI),the related images were transmitted offline to QFR workstation for analysis.According to the results of QFR in the acute phase,it was decided whether to perform elective revascularization of NCL.If QFR≤0.80,NCL would be treated,and if QFR>0.80,intensive drug treatment would be performed.At the time of elective intervention,QFR was measured again after angiography.The difference in QFR results were compared between the acute phase of NCL and the elective phase of NCL.All enrolled patients were followed up by telephone and outpatient service.Major adverse cardiac events(MACE)during 1 year after surgery were recorded,including all⁃cause death,recurrent myocardial infarction,and revascularization of target lesions.Results 108 patients were enrolled and completed offline QFR examination.30 ones with QFR≤0.80 received elective PCI on 32 NCL vessels,and 75 ones with QFR>0.80 received intensive drug therapy.In the 32 NCL vessels of 30 pa⁃tients undergoing elective PCI,the results of QFR measured at the time of elective intervention were highly correlated and con⁃sistent with those measured at the time of emergency[(0.73±0.08)vs(0.73±0.09),r=0.94],with a mean difference of(0.01±0.06).Using QFR≤0.80 as the standard,when quantitative coronary angiography(QCA)diameter stenosis≥70%was used to determine the functional significance of the lesion,its accuracy was only 75.9%.Among the enrolled patients,107 ones(99.1%)completed 1⁃year clinical follow⁃up.Among patients with QFR≤0.80,one(3.0%)developed non⁃STEMI,and one(3.0%)underwent target vessel revascularization.Among patients with QFR>0.80,two ones(1.3%)underwent tar⁃get vessel revascularization.Concl

关 键 词：老年 定量血流分数 急性心肌梗死 多支病变 

分 类 号：R542.22[医药卫生—心血管疾病]