血流储备分数指导女性冠状动脉临界病变的治疗及预后研究
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摘要
目的研究血流储备分数(FFR)指导女性冠状动脉临界病变的治疗及预后。方法纳入我院行冠状动脉造影为临界病变的患者270例,其中男性160例,女性110例,根据FFR值决定治疗方案,比较男性与女性临床资料特征、FFR值、PCI比例及随访期间主要不良心血管事件(MACE)发生率。结果女性患者年龄、合并高血压及高脂血症比例高于男性,既往心肌梗死、吸烟和饮酒史比例低于男性,差异有统计学意义(P<0.05,P<0.01)。女性FFR值明显高于男性,差异有统计学意义(0.85±0.08 vs 0.83±0.08,P=0.036)。男性与女性行PCI比例比较,差异无统计学意义(29.4%vs 24.5%,P=0.382)。完成临床随访患者262例中,男性156例,发生MACE 7例;女性106例,发生MACE 8例,男性与女性MACE发生率比较,差异无统计学意义(4.5%vs 7.5%,P=0.295)。Kaplan-Meier生存曲线显示,男性与女性生存率比较,差异无统计学意义(95.5%vs 92.5%,P=0.366)。结论临界病变的FFR值有性别差异,女性的FFR值较男性高;FFR指导临界病变治疗的预后无性别差异。
Objective To study the fractional flow reserve(FFR)-guided treatment of coronary artery borderline lesions and its outcome in female patients.Methods Two hundred and seventy patients(160 males and 110 females)with coronary borderline lesions who underwent coronary angiography in our hospital were included in this study.The patients were treated according to their FFR.The clinical data,FFR value,PCI rate and incidence of MACE during the follow-up period were compared between male and female patients.Results The age was significantly older,the incidence of hypertension and hyperlipidemia was signjificantly higher while the history of myocardial infarction,smoking and alcohol consumption was significantly lower in female patients than in male patients(P<0.05,P<0.01).The FFR value was significantly higher in female patients than in male patients(0.85±0.08 vs 0.83±0.08,P=0.036).No significant difference was detected in PCI rate bwtween male and female patients(29.4%vs 24.5%,P=0.382).Two hundred and sixty-two patients were followed up,during which MACE occurred in 7 out of the 156 male patients and in 8 out of the 106 female patients.No significant difference was detected in the incidence of MCAE between male and female patients(4.5% vs 7.5%,P=0.295).Kaplan-Meier survival curve showed no significant difference in the survival rate between male and female patients(95.5%vs 92.5%,P=0.366).Conclusion The FFR value is higher in female patients than in male patients.No gender difference is found in the outcome of FFR-guided treatment of coronary borderline lesions.
Objective To study the fractional flow reserve(FFR)-guided treatment of coronary artery borderline lesions and its outcome in female patients.Methods Two hundred and seventy patients(160 males and 110 females)with coronary borderline lesions who underwent coronary angiography in our hospital were included in this study.The patients were treated according to their FFR.The clinical data,FFR value,PCI rate and incidence of MACE during the follow-up period were compared between male and female patients.Results The age was significantly older,the incidence of hypertension and hyperlipidemia was signjificantly higher while the history of myocardial infarction,smoking and alcohol consumption was significantly lower in female patients than in male patients(P<0.05,P<0.01).The FFR value was significantly higher in female patients than in male patients(0.85±0.08 vs 0.83±0.08,P=0.036).No significant difference was detected in PCI rate bwtween male and female patients(29.4%vs 24.5%,P=0.382).Two hundred and sixty-two patients were followed up,during which MACE occurred in 7 out of the 156 male patients and in 8 out of the 106 female patients.No significant difference was detected in the incidence of MCAE between male and female patients(4.5% vs 7.5%,P=0.295).Kaplan-Meier survival curve showed no significant difference in the survival rate between male and female patients(95.5%vs 92.5%,P=0.366).Conclusion The FFR value is higher in female patients than in male patients.No gender difference is found in the outcome of FFR-guided treatment of coronary borderline lesions.
引文
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[10]Coutinho T,Mielniczuk LM,Srivaratharajah K,et al.Coronary artery microvascular dysfunction:role of sex and arterial load[J].Int J Cardiol,2018,270:42-47.DOI:10.1016/j.ijcard.2018.06.072.
[2]Prasad S,Harikrishnan S,Sanjay G,et al.Clinical outcomes of patients with coronary artery disease who underwent FFRevaluation of intermediate coronary lesionS-COFFRS study[J].Indian Heart J,2017,69(4):499-504.DOI:10.1016/j.ihj.2016.12.007.
[3]Kim CH,Koo BK,Lee JM,et al.Influence of sex on relationship between total anatomical and physiologic disease burdens and their prognostic implications in patients with coronary artery disease[J].J Am Heart Assoc,2019,8(5):e011002.DOI:10.1161/JAHA.118.011002
[4]Ihdayhid AR,Yong A,Harper R,et al.A practical guide for fractional flow reserve guided revascularisation[J].Heart Lung Cir,2018,27(4):406-419.DOI:10.1016/j.hlc.2017.09.017.
[5]Van Belle E,Rioufol G,Pouillot C,et al.Outcome impact of coronary revascularization strategy reclassification with fractional flow reserve at time of diagnostic angiography:insights from a large French multicenter fractional flow reserve registry[J].Circulation,2014,129(2):173-185.DOI:10.1161/CIRCULATIONAHA.113.006646.
[6]Park SH,Jeon KH,Lee JM,et al.Long-term clinical outcomes of fractional flow reserve-guided versus routine drugeluting stent implantation in patients with intermediate coronary stenosis:five-year clinical outcomes of DEFER-DES Trial[J].Circ Cardiovasc Interv,2015,8(12):e002442.DOI:10.1161/CIRCINTERVENTIONS.115.002442.
[7]Lakhter V,Alkhouli M,Zack CJ,et al.Sex differences in fractional flow reserve-guided fevascularization:a nationwide analysis[J].J Womens Health(Larchmt),2017,26(2):109-115.DOI:10.1089/jwh.2016.5806.
[8]Fineschi M,Guerrieri G,Orphal D,et al.The impact of gender on fractional flow reserve measurements[J].EuroIntervention,2013,9(3):360-366.DOI:10.4244/EIJV9I3A58.
[9]余铭,黄翔,丁娟,等.冠状动脉临界病变中冠状动脉血流储备分数相关因素分析[J].中华实用诊断与治疗杂志,2015,29(12):1179-1181.DOI:10.13507/j.issn.1674-3474.2015.12.012.
[10]Coutinho T,Mielniczuk LM,Srivaratharajah K,et al.Coronary artery microvascular dysfunction:role of sex and arterial load[J].Int J Cardiol,2018,270:42-47.DOI:10.1016/j.ijcard.2018.06.072.