FFR在非前降支临界病变介入治疗中的指导意义研究
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-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(Major Adverse Cardiovascular Events, 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。
引文
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[4]ElFaramawy A. 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]. Egypt Heart J, 2018, 70(2):95-100.
[5]Task Force Members, Montalescot G, Sechtem U, et al. 2013ESC guidelines on the management of stable coronary artery disease:the Task Force on the management of stable coronary artery disease of the European Society of Cardiology[J]. Eur Heart J, 2013, 34(38):2949-3003.
[6]Roberto Malagò, Pezzato A, Barbiani C, et al. Coronary artery anatomy and variants[J]. Pediatric Radiol, 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]. Int Heart J, 2013, 54(1):54-58.
[8]Asa numaT,Higash i ku n iY,Ya mash itaH,etal.Multimodality Intravascular Imaging to Evaluate Sex Differences in Plaque Morphology in Stable CAD[J]. JACC Cardiovasc Imaging, 2016, 9(4):400-407.
[9]BoudriotE,ThieleH,WaltherT,etal.Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis[J]. J Am Coll Cardiol, 2011, 57(5):538-545.
[10]Park SJ. Randomized trial of stents vs bypass surgery for left main coronary artery disease[J]. N Engl JMed 2011,364(18):1718–1727.
[2]Dancy L, Kevin O’Gallagher, Milton P, et al. New NICE guidelines for the management of stable angina[J]. Br J Gen Pract, 2017, 68(669):202.
[3]Ali A, Lambert S, Harald VB, et al. Effects of intima stiffness and plaque morphology on peak cap stress[J]. Biomedical Engineering Online, 2011, 10(1):25.
[4]ElFaramawy A. 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]. Egypt Heart J, 2018, 70(2):95-100.
[5]Task Force Members, Montalescot G, Sechtem U, et al. 2013ESC guidelines on the management of stable coronary artery disease:the Task Force on the management of stable coronary artery disease of the European Society of Cardiology[J]. Eur Heart J, 2013, 34(38):2949-3003.
[6]Roberto Malagò, Pezzato A, Barbiani C, et al. Coronary artery anatomy and variants[J]. Pediatric Radiol, 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]. Int Heart J, 2013, 54(1):54-58.
[8]Asa numaT,Higash i ku n iY,Ya mash itaH,etal.Multimodality Intravascular Imaging to Evaluate Sex Differences in Plaque Morphology in Stable CAD[J]. JACC Cardiovasc Imaging, 2016, 9(4):400-407.
[9]BoudriotE,ThieleH,WaltherT,etal.Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis[J]. J Am Coll Cardiol, 2011, 57(5):538-545.
[10]Park SJ. Randomized trial of stents vs bypass surgery for left main coronary artery disease[J]. N Engl JMed 2011,364(18):1718–1727.