经皮冠状动脉介入治疗术后定量血流分数对非急性心肌梗死患者术后3年主要不良心血管事件发生的预测价值  

Predictive value of quantitative flow ratio after percutaneous coronary intervention in the occurrence of major adverse cardiovascular events 3 years after surgery in patients with non-acute myocardial infarction

作　　者：柏中胜 肖栋 彭朝梅 曹龙兴 张小敏 肖国胜 BAI Zhong-sheng;XIAO Dong;PENG Chao-mei;CAO Long-xing;ZHANG Xiao-min;XIAO Guo-sheng(Department of Cardiology,the Affiliated Cardiovascular Hospital of Xiamen University,Xiamen 361006,China)

机构地区：[1]厦门大学附属心血管病医院心内科,福建厦门361006

出　　处：《中国介入心脏病学杂志》2023年第12期894-903,共10页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨非急性心肌梗死患者经皮冠状动脉介入治疗(PCI)术后定量血流分数(QFR)对术后3年主要不良心血管事件(MACE)发生的预测价值。方法本研究纳入厦门大学附属心血管病医院心脏导管室2020年1-6月行PCI的139例非急性心肌梗死患者,术后均测量靶血管QFR值,并随访患者术后3年MACE发生情况。通过受试者工作特征(ROC)曲线计算出QFR截断值,根据截断值将患者分成QFR>0.95组和QFR≤0.95组,根据是否发生MACE分成MACE组和非MACE组。通过单因素及多因素线性回归分析探讨非急性心肌梗死患者PCI术后QFR的独立影响因素,采用单因素及多因素Cox回归分析探讨PCI术后QFR对非急性心肌梗死患者术后3年MACE发生的预测价值。通过绘制无MACE生存曲线对比QFR>0.95组和QFR≤0.95组患者远期预后。结果通过ROC曲线分析得出PCI术后QFR预测非急性心肌梗死患者术后3年MACE发生有统计学意义(AUC 0.666,95%CI 0.556~0.777,P=0.003),且预测MACE发生的截断值为0.95,根据截断值将患者分为QFR≤0.95组(74例)和QFR>0.95组(65例)。多因素线性回归分析显示,PCI术后最大支架面积狭窄率是术后QFR的独立影响因素(P<0.001)。多因素Cox回归分析显示身体质量指数(BMI)、术后QFR、三支血管病变、术后QFR分组是无MACE生存期的独立影响因素。无MACE生存曲线显示:QFR>0.95组患者远期预后明显优于QFR≤0.95组(χ^(2)=5.272,P=0.022)。结论PCI术后QFR预测非急性心肌梗死患者术后3年MACE发生的最佳截断值为0.95,且术后QFR≤0.95的患者远期预后较差。BMI、三支血管病变、术后QFR≤0.95是非急性心肌梗死患者PCI术后3年MACE发生的独立危险因素。Objective To investigate the predictive value of quantitative f low ratio(QFR)on the occurrence of major adverse cardiovascular events(MACE)3 years af ter percu ta neous corona r y inter vention(PCI)in patients wit h non-acu te m yoca rdial infarction.Methods This study included 139 patients with non-acute myocardial infarction who underwent PCI from January 2020 to June 2020 in the cardiac catheterization room of our hospital,all of them underwent post-PCI target vessel QFR measurements,and the incidence of MACE was followed up 3 years after PCI.The cut-off value of QFR was calculated by receiver operating characteristic(ROC)curve,according to which patients were divided into QFR>0.95 group and QFR≤0.95 group,and patients were divided into MACE group and non-MACE group depending on whether MACE occurs.The independent influencing factors of post-PCI QFR in patients with non-acute myocardial infarction were investigated by univariate and multif actorial linear regression analysis.Univariate and multivariate Cox regression analysis was used to investigate the predictive value of post-PCI QFR in the occurrence of MACE 3 years after PCI in patients with non-acute myocardial infarction.The long-term prognosis of patients with QFR>0.95 and those with QFR≤0.95 was compared by drawing the survival cur ve of no-MACE event.Results ROC curve analysis showed that post-PCI QFR predicted the occurrence of MACE 3 years after surgery in non-acute myocardial infarction patients with statistical significance(AUC 0.666,95%CI 0.556–0.777,P=0.003),and the cut-off value of MACE was 0.95.The sensitivity and specificity were 75.00%and 51.30%for the diagnosis of MACE with QFR≤0.95.Patients were divided into QFR≤0.95 group(n=74)and QFR>0.95 group(n=65)according to the cut-off v alue.Mul tivariate linear regression analysis showed that the maximum area stenosis rate after PCI was an independent factor for post-PCI QFR(P<0.001).Multivariate Cox regression analysis showed that body mass index(BMI),post-PCI QFR,three-vessel lesions

关 键 词：经皮冠状动脉介入治疗 定量血流分数 非急性心肌梗死 主要不良心血管事件 

分 类 号：R541[医药卫生—心血管疾病]