宋荟芬,李红,李响,杨铎,韩静,贾若飞,孟帅,金泽宁

• 1:首都医科大学附属北京安贞医院急诊中心

摘要(Abstract)：

目的分析血流储备分数(FFR)与冠状动脉造影(CAG)指导的治疗对非ST段抬高急性冠状动脉综合征(NSTEACS)患者冠状动脉中度狭窄病变临床预后的影响。方法回顾性分析2014年7月1日至2015年7月30日在北京安贞医院行CAG显示为冠状动脉中度狭窄病变且行FFR检查的NSTEACS患者,共142例(FFR组),与同时期仅行CAG的NSTEACS冠状动脉中度狭窄患者以1∶2进行匹配,后者共284例(CAG组)。分析随访期间主要不良心血管事件(MACE,包括心原性死亡、靶血管血运重建、非致死性心肌梗死)发生情况。结果 FFR组行经皮冠状动脉介入治疗(PCI)的患者比例(36.6%比46.8%,P=0.037)、住院费用[(3.24±1.62)万元比(4.16±3.23)万元,P=0.033]、非致死性心肌梗死发生率(2.2%比4.5%,P=0.040)及靶血管血运重建率(5.9%比11.7%,P=0.046)均低于CAG组,差异均有统计学意义;而两组患者总MACE发生率及心原性死亡率比较,差异均无统计学意义(均P>0.05)。结论在NSTEACS患者中,FFR结合CAG指导的治疗可减少支架置入比例和住院费用,并可改善该类患者的临床预后。

关键词(KeyWords)： 冠状动脉造影;血流储备分数;冠状动脉中度狭窄;急性冠状动脉综合征;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 宋荟芬,李红,李响,杨铎,韩静,贾若飞,孟帅,金泽宁

参考文献(References)：

• [1]李琪,刘健,卢明瑜,等.血流储备分数与冠状动脉造影指导不稳定型心绞痛患者临界病变介入治疗效果的比较.中国介入心脏病学杂志,2014,22(1):7-11.
• [2]Lindstaedt M,Mugge A.Myocardial fractional flow reserve.Its role in guiding PCI in stable coronary artery disease.Herz,2011,36(5):410-416.
• [3]Zhang D,Lv S,Song X,et al.Fractional flow reserve versus angiography for guiding percutaneous coronary intervention:a meta-analysis.Heart,2015,101(6):455-462.
• [4]Park SJ,Ahn JM.Should we be using fractional flow reserve more routinely to select stable coronary patients for percutaneous coronary intervention?Curr Opin Cardiol,2012,27(6):675-681.
• [5]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(11):1183-1189.
• [6]Lerakis S,Synetos A,Toutouzas K,et al.Imaging of the vulnerable plaque:noninvasive and invasive techniques.Am J Med Sci,2008,336(4):342-348.
• [7]Dey S,Flather MD,Devlin G,et al.Sex-related differences in the presentation,treatment and outcomes among patients with acute coronary syndromes:the Global Registry of Acute Coronary Events.Heart,2009,95(1):20-26.
• [8]中华医学会心血管病分会.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南.中华心血管病杂志,2007,35(4):295-304.
• [9]于一,刘宇扬,史冬梅,等.血流储备分数在急性冠状动脉综合征患者冠状动脉介入治疗中的作用.中国介入心脏病学杂志,2015,23(6):353-356.
• [10]Pijls NH,Fearon WF,Tonino PA,et al.Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease:2-year followup of the FAME(Fractional Flow Reserve Versus Angiography for Multivessel Evaluation)study.J Am Coll Cardiol,2010,56(3):177-184.
• [11]朱贵家,刘洋洋,曹阳,等.血流储备分数指导经皮冠状动脉介入治疗术中非罪犯中度狭窄血管治疗策略的研究.中国介入心脏病学杂志,2014(10):626-631.
• [12]Finn AV,Nakano M,Narula J,et al.Concept of vulnerable/unstable plaque.Arterioscler Thromb Vasc Biol,2010,30(7):1282-1892.
• [13]Shah PK.Inflammation and plaque vulnerability.Cardiovasc Drugs Ther,2009,23(1):31-40.
• [14]López-Palop R,Carrillo P,Frutos A,et al.Usefulness of the fractional flow reserve derived by intracoronary pressure wire for evaluating angiographically intermediate lesions in acute coronary syndrome.Rev Esp Cardiol,2010,63(6):686-694.