计算机断层扫描衍生血流储备分数对稳定型胸痛临床管理的价值  

Value of computed tomography-fractional flow reservein the clinical management of stable chest pain

作　　者：杨国立 马康华[1] 罗悦 吴凡[1] 杨宝 毛敏[1] YANG Guoli;MA Kanghua;LUO Yue;WU Fan;YANG Bao;MAO Min(Department of Cardiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第一医院心血管内科,重庆400010

出　　处：《现代医药卫生》2023年第23期3970-3976,共7页Journal of Modern Medicine & Health

基　　金：重庆市自然科学基金面上项目(cstc2021jcyj-msxmX0077)。

摘　　要：目的 探讨使用冠状动脉CT血流储备分数(CT-FFR)作为侵入性冠状动脉造影(ICA)的替代方案在选择冠状动脉介入治疗患者时的安全性和可行性。方法 对2021年4月至2022年8月就诊于该院的稳定型胸痛且经冠状动脉CT血管造影诊断其冠状动脉狭窄超过50%的病例进行ICA和回顾性CT-FFR评估,比较CT-FFR与ICA在1年随访中对决策和临床结果方面的影响。结果 使用CT-FFR>0.80作为干预截止值,在识别冠状动脉狭窄方面具有较高的诊断能力(曲线下面积为0.85),同时可避免高达40%的诊断性ICA程序操作。在接受血运重建的CT-FFR≤0.80的患者中,类似于ICA引导的干预措施(21.1%),主要不良心血管事件发生率为18.8%。结论 CT-FFR可作为指导血运重建的替代工具,具有较高的冠状动脉介入手术取消率和较低的不良心血管事件发生率。Objective To investigate the safety and feasibility of using coronary arterycomputed tomography-fractional flow reserve(CT-FFR)as an alternative to invasive coronary angiography(ICA)for selecting patients for coronaryintervention.Methods ICA and retrospective CT-FFR were performedin patients with stable chest pain and coronary artery stenosis exceeding 50%diagnosed through coronary arterycomputed tomography angiography in this hospital from April 2021 to August 2022.The impact of CT-FFR and ICA on decision-making and clinical outcomes were compared inone-year follow-up.Results UsingCT-FFR threshold>0.80 for intervention demonstrated high diagnostic accuracy in identifying coronary artery stenosis(the area under the curve was 0.85),and at the same time,up to 40%of diagnostic ICA program operation search could be avoided.In patients with CT-FFR≤0.80 undergoing revascularization,the incidence of major adverse cardiovascular events was 18.8%,similar to ICA-guided intervention(21.1%).Conclusion The results indicate that CT-FFR can be used as an alternative tool to guide coronary revascularization,with high cancellation rate of coronary intervention and low incident rate..

关 键 词：冠状动脉CT血流储备分数 有创性冠状动脉造影 冠状动脉计算机断层扫描血管造影 稳定型胸痛 心血管事件 

分 类 号：R445[医药卫生—影像医学与核医学]