刘华云,何蕾,鄢华,汪敏,宋丹,苏晞

• 1:武汉亚洲心脏病医院心内科

摘要(Abstract)：

目的研究心肌血流储备分数(FFR)指导下药物治疗冠状动脉临界病变患者的安全性。方法 2010年4月至2011年9月武汉亚洲心脏病医院介入中心行冠状动脉造影提示临界病变同时行冠状动脉内压力导丝测定FFR≥0.8的连续15例患者,规范冠心病二级预防药物治疗。随访≥1年,包括主要不良事件(包括死亡、心肌梗死、再次靶病变血运重建术、卒中)及再发心绞痛、再次住院、出血发生情况。结果 15例患者平均(61±7.49)岁。其中男性7例(46.7%),冠状动脉造影病变平均(1.2±0.5)支。15例患者冠状动脉造影提示19处临界病变:左前降支15处、回旋支3处,右冠状动脉1处;其中单支病变者11例(73.3%),双支病变者4例(26.7%),均合并前降支病变;FFRmyo均值(0.88±0.06)。15例患者平均随访(23.6±5.67)个月,其中1例(6.7%)失访。2例(13.3%)不稳定型心绞痛患者随访期间出现心绞痛,症状较前无明显加重,含服硝酸甘油可缓解,余心肌梗死、再次靶病变血运重建术、卒中、全因死亡、再次住院率、出血等不良事件无发生。对入选患者心绞痛发生情况采用Kaplan-Meier法做生存分析,FFR术后平均再发心绞痛时间为术后(29.12±0.67)个月。结论初步验证了FFR指导下药物治疗冠状动脉临界病变患者是可行的。

关键词(KeyWords)： 心肌血流储备分数;冠状动脉临界病变;药物治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘华云,何蕾,鄢华,汪敏,宋丹,苏晞

参考文献(References)：

• [1]Kim HS,Tonino PA,De Bruyne B,et al.The Impact of Sex Differences on Fractional Flow Reserve-Guided Percutaneous Coronary Intervention:A FAME(Fractional Flow Reserve Versus Angiography for Multivessel Evaluation)Substudy.JACC Cardiovasc Interv,2012,5:1037-1042.
• [2]Pijls NH,De Bruyne B,Peels K,et al.Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses.N Engl J Med,1996,334:1703-1708.
• [3]葛均波.冠心病介入治疗进展(8)冠状动脉内超声、多普勒、压力导丝应用进展.中国循环杂志,2003,18:164-167.
• [4]Iskander S,Iskandrian AE.Risk assessment using single-photon emission computed tomographic technetium-99m sestamibi imaging.J Am Coll Cardiol,1998,32:57-62.
• [5]Kern MJ,Samady H.Current concepts of integrated coronary physiology in the catheterization laboratory.J Am Coll Cardiol,2010,55:173-185.
• [6]Wijns W,Kolh P,Danchin N,et al.Guidelines on myocardial revascularization.Eur Heart J,2010,31:2501-2555.
• [7]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.
• [8]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,2007,49:2105-2111.
• [9]Miller LH,Toklu B,Rauch J,et al.Very long-term clinical follow-up after fractional flow reserve-guided coronary revascularization.J Invasive Cardiol,2012,24:309-315.
• [10]Falk E,Shah PK,Fuster V.Coronary plaque disruption.Circulation,1995,92:657-671.
• [11]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.
• [12]Ray KK,Cannon CP,McCabe CH,et al.Early and late benefits of high-dose atorvastatin in patients with acute coronary syndromes:results from the PROVE IT-TIMI22trial.J Am Coll Cardiol,2005,46:1405-1410.