PCI术后支架段QFR对重度冠脉钙化患者旋磨后支架内再狭窄的预测价值分析  

Analysis of the Value of Stent QFR after PCI for Predicting in-stent Restenosis in Patients with Severe Coronary Calcification after Rotational Atherectomy

作　　者：甘建祥 吴志明[1] 尤威[1] 黄天熠[1] 叶飞[1] 吴向起[1] GAN Jian-xiang;WU Zhi-ming;YOU Wei;HUANG Tian-yi;YE Fei;WU Xiang-qi(Department of Cardiology,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing First Hospital,Nanjing,Jiangsu,210001,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)心血管内科,江苏南京210001

出　　处：《现代生物医学进展》2025年第7期1152-1159,共8页Progress in Modern Biomedicine

基　　金：南京市卫生科技发展专项资金项目计划(YKK22101)。

摘　　要：目的:探讨经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后即刻支架段定量血流分数(quantitative flow ratio,QFR)对重度冠脉钙化(severely coronary calcified lesion,SCCL)患者发生旋磨(rotational atherectomy,RA)后支架内再狭窄(in-stent restenosis,ISR)的预测价值。方法:收集本院收治的SCCL并接受RA治疗的患者106例,根据1年后冠脉造影复查结果分为非ISR组(N=86)与ISR组(N=20),对两组患者的临床资料进行对比分析,单因素和多因素回归分析ISR的危险因素,受试者工作特征(receiver operating characteristic,ROC)曲线分析支架段QFR(stent QFR,QFRs)对预测发生ISR的截断值。结果:ISR组最终旋磨头直径、最终旋磨头直径与远端RVD比、PCI术后即刻MLD、PCI术后即刻QFRs明显低于非ISR组患者(P<0.05),直径狭窄(diameter stenosis,DS)率明显高于非ISR组患者(P<0.05)。单因素回归分析显示最终旋磨头与远端RVD比、PCI术后即刻DS和PCI术后即刻QFRs是SCCL患者RA后发生ISR的影响因素(P<0.05),多因素回归分析显示PCI术后即刻QFRs是预测SCCL患者RA后发生ISR较好的危险因素。ROC曲线分析显示QFRs预测SCCL患者RA后ISR的截断值为0.945,其敏感性为87.21%,其特异性为75.00%,尤登指数为0.622,曲线下面积为0.814(95%CI:0.731-0.898)(P<0.05)。结论:QFRs能用于预测SCCL患者RA后1年ISR的发生风险,且临床价值比最终旋磨头直径与远端RVD比以及PCI术后即刻DS具有一定的优势。Objective:To investigate the predictive value of the quantitative flow ratio(QFR)in stent segment(QFRs)immediately following percutaneous coronary intervention(PCI)for in-stent restenosis(ISR)in patients with severely calcified coronary lesions(SCCL)after undergoing rotational atherectomy(RA).Methods:A total of 106 patients with SCCL who received RA treatment at our institution were enrolled and subsequently categorized into a non-ISR group(N=86)and an ISR group(N=20),based on the outcomes observed through coronary angiography 1 year post-procedure.Clinical data from both groups were compared and analyzed.Univariate and multivariate regression analyses were conducted to identify risk factors associated with ISR.The receiver operating characteristic(ROC)curve was employed to determine the cut-off value of QFRs for predicting ISR.Results:In the ISR group,key parameters such as final burr size,the ratio of final burr size to distal reference vessel diameter(RVD),minimum lumen diameter(MLD)immediately after PCI,and QFRs immediately post-PCI were significantly lower than those observed in the non-ISR group(P<0.05).Conversely,the rate of diameter stenosis(DS)was notably higher in the ISR group compared to their counterparts in the non-ISR cohort(P<0.05).Univariate regression analysis indicated that the ratio of final burr size to distal RVD,DS immediately after PCI,and QFRs immediately post-PCI emerged as significant influencing factors for ISR following RA in SCCL patients(P<0.05).Furthermore,multivariate regression analysis confirmed that QFRs immediately after PCI serve as a better risk predictor for the occurrence of ISR in patients with SCCL after RA.ROC curve analysis revealed that a QFRs cut-off value of 0.945 effectively predicted ISR following RA in this patient population,demonstrating a sensitivity of 87.21%,specificity of75.00%,Youden index score of 0.622,and an area under curve measurement of 0.814[95%CI:0.731-0.898]with statistical significance noted at P<0.05.Conclusion:QFRs can be used to predict the ri

关 键 词：支架内再狭窄 定量血流分数 重度冠脉钙化 旋磨 

分 类 号：R3[医药卫生—基础医学] R541.4