FFR对稳定性心绞痛非前降支临界病变介入治疗的研究
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摘要
目的:探讨血流储备分数(fractional flow reserve,FFR)在非前降支临界病变介入治疗中的指导意义。方法:回顾2011年9月至2014年9月在南京脑科医院心内科住院的稳定型心绞痛的患者,收集这些患者中行冠脉造影显示为单支冠脉临界病变并且FFR值>0.8的患者83例共85处血管病变,将83例患者分为非前降支组(包括右冠及回旋支)32例34处病变和前降支组51例共51处病变,分析其随访期间(48个月)的主要不良心血管事件(MajorAdverseCardiovascularEvents,MACE),包括心绞痛发作、室性心律失常、靶血管血运重建、非致死性心肌梗死和心源性死亡。结果:在FFR值>0.8的稳定型心绞痛的患者中,非前降支组和前降支组的患者在临床基线资料如年龄、吸烟史、高脂血症病史、高血压病史等方面均无统计学差异,但非前降支组男性比例明显高于前降支组;通过定量冠状动脉造影测量,发现非前降支组患者的冠脉狭窄程度明显高于前降支组(P=0.000),但前降支组FFR值却明显低于非前降支组(P=0.000)。经过48个月的随访,非前降支组的MACE的发生率明显低于前降支组(P=0.006)。结论:在稳定型心绞痛的患者中,非前降支临界病变的患者较前降支临界病变的患者拥有更好的长期预后。
Aim: To explore the clinical significance of fractional flow reserve(FFR) in interventional therapy of non-anterior descending branch borderline lesions. Method: 83 patients with stable angina pectoris who were admitted to the department of cardiology of Nanjing Brain Hospital from September 2011 to September 2014 were selected. The patients were performed coronary angiography, which showed there was single coronary borderline lesion. Moreover, FFR value was greater than 0.8. The patients were divided into the non-anterior descending branch group including 32 patients and 34 lesions, and the anterior descending branch group including 51 patients and 51 lesions. Major Adverse Cardiovascular Events(MACE) during the follow-up period(48 months) were analyzed, including angina attack, ventricular arrhythmia, target vessel revascularization, non-fatal myocardial infarction and cardiac death. Results: In the patients with stable angina pectors with FFR>0.8, there were no significant differences between the two groups in clinical baseline data, such as age, smoking, hyperlipidemia, hypertension, etc. However, the proportion of male was significantly higher in the non-anterior descending group than in the anterior descending branch group. The degree of coronary artery stenosis was significantly higher in the non-anterior descending branch group than in the anterior descending branch group(P=0.000). However, the FFR value was significantly lower in the anterior descending branch group than the non-anterior descending branch group(P=0.000). After 48 months of follou-up, the incidence of MACE was significantly lower in the non-anterior descending branch group(P=0.006). Conclusion: Patients with stable angina pectoris who have borderline lesions in non-anterior descending branch may have better long-term prognosis.
Aim: To explore the clinical significance of fractional flow reserve(FFR) in interventional therapy of non-anterior descending branch borderline lesions. Method: 83 patients with stable angina pectoris who were admitted to the department of cardiology of Nanjing Brain Hospital from September 2011 to September 2014 were selected. The patients were performed coronary angiography, which showed there was single coronary borderline lesion. Moreover, FFR value was greater than 0.8. The patients were divided into the non-anterior descending branch group including 32 patients and 34 lesions, and the anterior descending branch group including 51 patients and 51 lesions. Major Adverse Cardiovascular Events(MACE) during the follow-up period(48 months) were analyzed, including angina attack, ventricular arrhythmia, target vessel revascularization, non-fatal myocardial infarction and cardiac death. Results: In the patients with stable angina pectors with FFR>0.8, there were no significant differences between the two groups in clinical baseline data, such as age, smoking, hyperlipidemia, hypertension, etc. However, the proportion of male was significantly higher in the non-anterior descending group than in the anterior descending branch group. The degree of coronary artery stenosis was significantly higher in the non-anterior descending branch group than in the anterior descending branch group(P=0.000). However, the FFR value was significantly lower in the anterior descending branch group than the non-anterior descending branch group(P=0.000). After 48 months of follou-up, the incidence of MACE was significantly lower in the non-anterior descending branch group(P=0.006). Conclusion: Patients with stable angina pectoris who have borderline lesions in non-anterior descending branch may have better long-term prognosis.
引文
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[2]Dancy L,Kevin O’Gallagher,Milton P,et al.New NICEguidelines for the management of stable angina[J].Br J Gen Pract,2018,68(669):202-203.
[3]Ali A,Lambert S,Harald V B,et al.Effects of intima stiffness and plaque morphology on peak cap stress[J].Biomedical Engineering Online,2011,10(1):25.
[4]Elfaramawy A,Youssef M,Ghany M A,et al.Difference in plaque characteristics of coronary culprit lesions in a cohort of Egyptian patients presented with acute coronary syndrome and stable coronary artery disease:An optical coherence tomography study[J].Egyptian Heart Journal,2018,70(2):95-100.
[5]Sechtem U,Achenbach S,Andreotti F,et al.2013 ESCguidelines on the management of stable coronary artery disease[J].European Heart Journal,2013,34(38):2949-3003.
[6]Roberto Malagò,Pezzato A,Barbiani C,et al.Coronary artery anatomy and variants[J].Pediatric Radiology,2011,41(12):1505-1515.
[7]Asanuma T,Higashikuni Y,Yamashita H,et al.Discordance of the areas of peak wall shear stress and tissue stress in coronary artery plaques as revealed by fluid-structure interaction finite element analysis:a case study[J].International Heart Journal,2013,54(1):54-58.
[8]Bharadwaj,A.S.Multimodality intravascular imaging to evaluate sex differences in plaque morphology in stable CAD[J].Jacc Cardiovascular Imaging,2016,9(4):400-407.
[9]Boudriot E,Thiele H.Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents vs.coronary artery bypass grafting in unprotected left main stem stenosis[J].J Am Coll Cardiol 2011,57(5):538-545.
[10]Park SJ,Kim YH.Randomized trial of stents vs.bypass surgery for left main coronary artery disease[J].N Engl JMed,2011,364(18):1718-1727.