李琪,刘健,卢明瑜,马玉良,赵红,丁荣晶,刘传芬,王伟民

• 1:北京大学人民医院心脏中心

摘要(Abstract)：

目的分析血流储备分数(FFR)与冠状动脉造影(CAG)指导的不稳定型心绞痛患者临界病变介入治疗的效果。方法回顾性分析2012年9月1日至2013年9月30日在北京大学人民医院心脏中心行CAG显示为临界病变且行FFR检查的不稳定型心绞痛患者,共收集41例患者的50处血管病变,与同时期行CAG的不稳定型心绞痛临界病变病例进行1:3匹配,分析其随访期间的主要不良心血管事件(包括心绞痛无缓解、再次靶血管血运重建、非致死性心肌梗死和心源性死亡)。结果 FFR介入治疗组共21例25处血管病变;FFR药物治疗组共20例25处血管病变;CAG介入治疗组共63例75处血管病变;CAG药物治疗组共60例75处血管病变。FFR介入治疗组术后的FFR平均值为(0.86±0.07),有4例4处血管(16%)的术后FFR≥0.94,达到了介入治疗结果理想的标准;有13例17处血管(68%)的术后FFR在0.80~0.94的可接受范围内;其余4例4处血管(16%)的术后FFR<0.80。FFR指导治疗的2组病例和CAG指导治疗的2组病例术后总的主要不良心血管事件(包括死亡、非致死性心肌梗死、再次靶血管血运重建和心绞痛缓解情况)差异有统计学意义(P=0.000)。在随访过程中4组均无心源性死亡病例,非致死性心肌梗死的发生率在各组间的差异无统计学意义。心绞痛缓解情况在FFR指导治疗的两组中最为明显,明显缓解的比例高于CAG指导治疗的两组,而明显缓解+部分缓解的比例达到了100%,也高于CAG指导治疗的两组(P=0.002),差异有统计学意义。再次靶血管血运重建的情况在FFR指导治疗的两组中也明显低于CAG指导治疗的两组,尤其是FFR药物治疗组无再次靶血管血运重建事件发生。而CAG药物治疗组在随访过程中由于心绞痛无明显缓解等原因再次行靶血管血运重建的比例最高(P=0.008),差异有统计学意义。结论采用FFR检查可以准确的识别不稳定型心绞痛患者临界病变是否缺血,用于指导介入治疗可以降低术后的主要不良心血管事件。

关键词(KeyWords)： 冠状动脉;血流储备分数;临界病变;不稳定型心绞痛

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 李琪,刘健,卢明瑜,马玉良,赵红,丁荣晶,刘传芬,王伟民

参考文献(References)：

• [1]Bech GJ,De Bruyne B,Pijls NH,et al.Fractional fl ow reserve to determine the appropriateness of angioplasty in moderate coronary stenosis:a randomized trial.Circulation,2001,103:2928-2934.
• [2]Pijls NH,van Schaardenburgh P,Manoharan G,et al.Percutaneous coronary intervention of functionally nonsignifi cant stenosis:5-year follow-up of the DEFER Study.J Am Coll Cardiol,2007,49:2105-2111.
• [3]De Bruyne B,Pijls NH,Kalesan B,et al.Fractional flow reserve guided PCI versus medical therapy in stable coronary disease.N Engl J Med,2012,367:991-1001.
• [4]Tonino PA,De Bruyne B,Pijls NH,et al.Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.N Engl J Med,2009,360:213-224.
• [5]Hernández García MJ,Alonso-Briales JH,Jiménez-Navarro M,et al.Clinical management of patients with coronary syndromes and negative fractional flow reserve findings.J Interv Cardiol,2001,14:505-509.
• [6]Fischer JJ,Wang XQ,Samady H,et al.Outcome of patients with acute coronary syndromes and moderate coronary lesions undergoing deferral of revascularization based on fractional flow reserve assessment.Catheter Cardiovasc Interv,2006,68:544-548.
• [7]Esen AM,Acar G,Esen O,et al.The prognostic value of combined fractional flow reserve and TIMI frame count measurements in patients with stable angina pectoris and acute coronary syndrome.J Interv Cardiol,2010,23:421-428.
• [8]Miller LH,Toklu B,Rauch J,et al.Very long-term clinical followup after fractional fl ow reserve-guided coronary revascularization.J Invasive Cardiol,2012,24:309-315.
• [9]刘学波,刘媛,葛均波.心肌血流储备分数和血管内超声联合评价冠状动脉临界性病变:附二例报告.中国介入心脏病学杂志,2009,17:108-110.
• [10]刘华云,何蕾,鄢华,等.心肌血流储备分数指导下药物治疗冠状动脉临界病变患者的远期疗效.中国介入心脏病学杂志,2013,21:220-222.
• [11]Lansky AJ,Goto K,Cristea E,et al.Clinical and angiographic predictors of short-and long-term ischemic events in acute coronary syndromes:results from the acute catheterization and urgent intervention triage strategy(ACUITY)trial.Circ Cardiovasc Interv,2010,3:308-316.
• [12]Sels JW,Tonino PA,Siebert U,et al.Fractional flow reserve in unstable angina and non-ST-segment elevation myocardial infarction experience from the FAME(Fractional flow reserve versus Angiography for Multivessel Evaluation)study.JACC Cardiovasc Interv,2011,4:1183-1189.