李全,杨帮国,叶益聪,赵昔良,曾勇

• 1:首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所
• 2:云南省阜外心血管病医院心内科

摘要(Abstract)：

目的探讨真实世界中基于血流储备分数(FFR)指导下左前降支近段(pLAD)病变与非pLAD病变的不同血运重建策略对临床预后的影响。方法纳入618例在首都医科大学附属北京安贞医院接受FFR指导血运重建的冠心病患者,根据病变是否累及pLAD将患者分为pLAD组(289例)和非pLAD组(329例),比较两组患者的主要不良心血管事件(MACE)发生率。采用KaplanMeier法描述生存率,Cox比例风险模型计算组间风险比和多因素校正分析。结果中位随访时间为21.0(17.0,29.0)个月,单因素Cox回归分析显示,pLAD组、经皮冠状动脉介入治疗、接受FFR测量血管数、病变血管数、病变数、近段病变数、置入支架数、置入支架总长度和小血管置入支架患者数均与MACE的发生率增加相关(均P<0.05)。多元Cox比例风险回归模型显示,pLAD组(HR 2.480,95%CI 1.26～4.87,P=0.008)和置入支架数(HR 1.546,95%CI1.08～2.21,P=0.017)是MACE的独立预测因素。结论基于FFR指导血运重建的临床实践中,病变累及pLAD和置入支架数量均与冠心病患者的不良预后相关。

关键词(KeyWords)： 左前降支近段;血流储备分数;血运重建策略;预后

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金（82070301）

作者(Author): 李全,杨帮国,叶益聪,赵昔良,曾勇

参考文献(References)：

• [1] Roguin A, Camenzind E, Kerner A, et al. Long-term outcomes of stenting the proximal left anterior descending artery in the PROTECT trial. JACC Cardiovasc Interv, 2017, 10(6):548-556.
• [2] Calais F, Lagerqvist B, Leppert J, et al. Proximal coronary artery intervention:stent thrombosis, restenosis and death. Int J Cardiol,2013, 170(2):227-232.
• [3] Lemos PA, Hoye A, Goedhart D, et al. Clinical, angiographic,and procedural predictors of angiographic restenosis after sirolimuseluting stent implantation in complex patients:an evaluation from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital(RESEARCH)study. Circulation,2004,109(11):1366-1370.
• [4] Li Q, Yu X, He J, et al. The relationship between revascularization extent and the long-term prognosis of patients with stable angina pectoris and three-vessel disease treated by percutaneous coronary intervention in the era of drug-eluting stents. Clin Cardiol, 2014, 37(9):566-575.
• [5] De Bruyne B, Pijls NH, Kalesan B, et al. Fractional fl ow reserveguided PCI versus medical therapy in stable coronary disease. N Engl J Med, 2012, 367(11):991-1001.
• [6] Layland J, Oldroyd KG, Curzen N, et al. Fractional fl ow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction:the British Heart Foundation FAMOUS-NSTEMI randomized trial. Eur Heart J,2015, 36(2):100-111.
• [7] Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis:5-year follow-up of the DEFER study. J Am Coll Cardiol, 2007, 49(21):2105-2111.
• [8] Fukunaga M, Fujii K, Mintz GS, et al. Distribution of pressure gradients along the left anterior descending artery in patients with angiographic ally normal arteries. Catheter Cardiovasc Interv,2020, 96(1):E67-E74.
• [9]《中国冠状动脉血流储备分数测定技术临床路径专家共识》专家组.中国冠状动脉血流储备分数测定技术临床路径专家共识.中国介入心脏病学杂志，2019,27(3):121-133.
• [10] Myers WO, Blackstone EH, Davis K, et al. CASS registry long term surgical survival. Coronary Artery Surgery Study. J Am Coll Cardiol, 1999, 33(2):488-498.
• [11] Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal defi nition of myocardial infarction(2018). J Am Coll Cardiol,2018, 72(18):2231-2264.
• [12] Kennedy MW, Fabris E, Ijsselmuiden AJ, et al. Combined optical coherence tomography morphologic and fractional flow reserve hemodynamic assessment of non-culprit lesions to better predict adverse event outcomes in diabetes mellitus patients:COMBINE(OCT-FFR)prospective study. Rationale and design.Cardiovasc Diabetol, 2016, 15(1):144.
• [13] Nam CW, Hur SH, Cho YK, et al. Relation of fractional fl ow reserve after drug-eluting stent implantation to one-year outcomes.Am J Cardiol, 2011, 107(12):1763-1767.
• [14] Yaeger IA. A multi-artery fractional fl ow reserve(FFR)approach for handling coronary stenosis-stenosis interaction in the multi-vessel disease(MVD)arena. Int J Cardiol, 2016, 203:807-815.