摘要
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.
Objective To analyse effect of FFR-guided versus CAG-guided percutaneous coronary intervention in borderline lesions of unstable angina pectoris. Methods Unstable angina pectoris patients with borderline lesions who accepted FFR from Sep 1, 2012 to Sep 30, 2013 in Peking University People＇s Hospital were analyzed retrospectively. There were 41 cases with 50 vessels were registered, which were matched as 1：3 with unstable angina pectoris cases which had borderline lesions guided by coronary angiography in the same period. The major adverse cardiovascular events （including unrelieved angina, target vessel revascularization, non-fatal myocardial infarction and cardiac death） in the follow-up period are analyzed. Results Compared with CAG-guided patients, cases whose FFR ≤ 0.8 accepted PCI and cases whose FFR 〉 0.8 accepted medicine treatment had excellent results, whose major adverse cardiovascular events decreased significantly （P=0.000）, especially angina totally remitted plus partially remitted were 100%, significantly higher than CAG-guided cases （P=0.002）, and target vessel revascularization rate in FFR-guided cases decreased significantly than CAG-guided cases （4.8%, 0%, 12.7% and 26.7%, respectively, P=0.008）. Non-fatal myocardial infarction rate and cardiac death rate didn＇t have statistical importance between FFR-guided cases and CAG-guided cases （P=0.737, P=NS, respectively）. Conclusions FFR can identify exactly whether there were ischemia in borderline lesions of unstable angina pectoris cases, PCI guided with FFR can decrease major adverse cardiovascular events.
出处
《中国介入心脏病学杂志》
2014年第1期7-11,共5页
Chinese Journal of Interventional Cardiology
关键词
冠状动脉
血流储备分数
临界病变
不稳定型心绞痛
Coronary artery
Fractional flow reserve
Borderline lesions
Unstable angina pectoris
