血流储备分数指导下分期PCI干预非梗死相关动脉对STEMI患者短期预后的影响
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摘要
目的:探讨血流储备分数(FFR)指导下分期行经皮冠状动脉(冠脉)介入术(PCI)干预非梗死相关动脉(non-IRA)对ST段抬高型心肌梗死(STEMI)患者预后的影响。方法:将100例拟分期PCI干预non-IRA的STEMI患者随机分为FFR指导下功能性血运重建组(FFR组)和单纯冠脉造影指导下血运重建组(CAG组),各50例。FFR组对狭窄70%～90%的non-IRA行FFR检查,FFR≤0.80为PCI干预的指证;CAG组对狭窄≥70%的non-IRA仅冠脉造影指导下行PCI。比较2组PCI资料和住院期间主要并发症,均术后随访12个月,比较2组术后1个月和12个月时主要不良心血管事件(MACE)的发生率。结果:FFR组和CAG组比较,人均支架植入量[(1.5±0.5)枚∶(2.6±1.0)枚,P≤0.01]和支架植入率[84.2%∶100%,P=0.003]显著降低;2组的PCI时间、造影剂剂量、住院时间、住院费用和住院期间主要并发症均无统计学差异;术后1个月FFR组未增加MACE事件发生率[1例(2%)∶3例(6%),P=0.617];术后12个月FFR组MACE事件[2例(4.08%)∶8例(16.70%),P=0.042]显著降低。结论:对STEMI多支血管病变患者在FFR指导下non-IRA分期功能性血运重建可减少不必要的PCI干预,降低术后12个月的MACE事件发生率。
Objective:To investigate the prognostic impact of staged PCI intervention on non-infarct related artery guided by FFR in patients with ST segment elevation myocardial infarction.Method:One hundred cases of STEMI patients were randomly divided into functional revascularization group guided by FFR(FFR group) and coronary angiography guided revascularization group(CAG group). Patients assigned to FFR group underwent stenting of indicated lesions only if FFR≤0.80,whereas those assigned to CAG group underwent stenting of all indicated lesions with stenosis≥70%. The coronary angiography results and the data of PCI were recorded. The number of stent used per patient,procedure time,hospitalization time,the amount of contrast agent used per patient and major complications during hospitalization were compared between the two groups. Patients were followed up for 12 months,the incidence of major adverse cardiovascular events(MACE) was compared between the two groups in one month and six months after PCI surgery.Result:Compared with CAG group,FFR group had decreased mean number of stents [(1.5±0.5) vs(2.6±1.0),P<0.01] and stent implantation rate [84.2% vs 100%,P=0.003]. There were no obvious difference in procedure time,the amount of contrast agent used per patient,the hospitalization time,hospitalization expenses and major complications during hospitalization between the two groups. In addition,there was no obvious difference in the incidence of MACE between the two groups in one month,but the incidence of MACE was obviously decreased in FFR group in six months after PCI surgery. Conclusion:Staged PCI functional revascularization can reduce unnecessary PCI intervention and the incidence of MACE events in 12 months after surgery in patients with ST segment elevation myocardial infarction and multivessel disease.
Objective:To investigate the prognostic impact of staged PCI intervention on non-infarct related artery guided by FFR in patients with ST segment elevation myocardial infarction.Method:One hundred cases of STEMI patients were randomly divided into functional revascularization group guided by FFR(FFR group) and coronary angiography guided revascularization group(CAG group). Patients assigned to FFR group underwent stenting of indicated lesions only if FFR≤0.80,whereas those assigned to CAG group underwent stenting of all indicated lesions with stenosis≥70%. The coronary angiography results and the data of PCI were recorded. The number of stent used per patient,procedure time,hospitalization time,the amount of contrast agent used per patient and major complications during hospitalization were compared between the two groups. Patients were followed up for 12 months,the incidence of major adverse cardiovascular events(MACE) was compared between the two groups in one month and six months after PCI surgery.Result:Compared with CAG group,FFR group had decreased mean number of stents [(1.5±0.5) vs(2.6±1.0),P<0.01] and stent implantation rate [84.2% vs 100%,P=0.003]. There were no obvious difference in procedure time,the amount of contrast agent used per patient,the hospitalization time,hospitalization expenses and major complications during hospitalization between the two groups. In addition,there was no obvious difference in the incidence of MACE between the two groups in one month,but the incidence of MACE was obviously decreased in FFR group in six months after PCI surgery. Conclusion:Staged PCI functional revascularization can reduce unnecessary PCI intervention and the incidence of MACE events in 12 months after surgery in patients with ST segment elevation myocardial infarction and multivessel disease.
引文
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[11] Kornowski R,Mehran R,Dangas G,et al.Prognostic impact of staged versus "one-Time" multivessel percutaneous intervention in acute myocardial infarction:analysis from the HORIZONS-AMI(harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial[J].J Am Coll Cardiol,2011,58(7):704-711.
[12] Manari A,Varani E,Guastaroba P,et al.Long-term outcome in patients with ST segment elevation myo-Echocardiogram cardial infarction and multivessel disease treated with culprit-only,immediate,or staged multivessel percutaneous revascularization strategies:Insights from the REAL registry[J].Catheter Cardiovasc Interv,2014,84(6):912-922.
[13]Siebert U,Arvandi M,Gothe RM,et al.Improving the quality of percutaneous revascularisation in patients with multivessel disease in Australia:cost-effectiveness,public health implications,and budget impact of FFR-guided PCI[J].Heart Lung Circ,2014,23(6):527-533.
[14]Zhang D,Lv S,Song X,et al.Fractional flow reserve versus angiography for guiding percutaneous coronaryintervention:a meta-analysis[J].Heart,2015,101(6):455-462.
[15]王明礼,刘建平,钟理,等.血流储备分数在多支血管病变患者中指导经皮冠状动脉介入治疗疗效的荟萃分析[J].重庆医学,2014,43(7):823-825.
[16]Engstr?m T,Kelb?k H,Helqvist S,et al.Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease(DANAMI-3-PRIMULTI):an open-label,randomised controlled trial[J].Lancet,2015,386(9994):665-671.
[2] Widimsky P,Holmes DR Jr.How to treat patients with ST-elevation acute myocardial infarction and multi-vessel disease?[J].Eur Heart J,2011,32(4):396-403.
[3] Hannan EL,Samadashvili Z,Walford G,et al.Culprit vessel percutaneous coronary intervention versus multivessel and staged coronary intervention for ST-segment elevation myocardial infarction patients with multivessel disease[J].JACC Cardiovasc Interv,2010,3(1):22-31.
[4] 中华医学会心血管病学会介入心脏病学组,中华心血管病杂志编辑委员会.中国经皮冠脉介入治疗指南2012[J].中华心血管病杂志,2012,40(4):271-277.
[5] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[6] 李潇颖,缪黄泰,张明,等.急性ST段抬高型心肌梗死的梗死部位与并发心脏破裂患者的特征及预后研究[J].临床心血管病杂志,2017,33(12):1196-1201.
[7] Steg PG,James SK,Atar D,et al.ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology(ESC)[J].European Heart J,2012,33(20):2569-2619.
[8] Zhang D,Song X,Lv S,et al.Culprit vessel only versus multivessel percutaneous coronary intervention in patients presenting with ST-segment elevation myocardial infarction and multivessel disease[J].PLoS One,2014,9(3):e92316.
[9] Wald DS,Morris JK,Wald NJ,et al.Randomized trial of preventive angioplasty in myocardial infarction[J].N Engl J Med,2013,369(12):1115-1123.
[10] Gershlick AH,Khan JN,Kelly DJ,et al.Randomized Trial of Complete Versus Lesion-Only Revascularization in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI and Multivessel Disease:The CvLPRIT Trial[J].J Am Coll Cardiol,2015,65(10):963-972.
[11] Kornowski R,Mehran R,Dangas G,et al.Prognostic impact of staged versus "one-Time" multivessel percutaneous intervention in acute myocardial infarction:analysis from the HORIZONS-AMI(harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial[J].J Am Coll Cardiol,2011,58(7):704-711.
[12] Manari A,Varani E,Guastaroba P,et al.Long-term outcome in patients with ST segment elevation myo-Echocardiogram cardial infarction and multivessel disease treated with culprit-only,immediate,or staged multivessel percutaneous revascularization strategies:Insights from the REAL registry[J].Catheter Cardiovasc Interv,2014,84(6):912-922.
[13]Siebert U,Arvandi M,Gothe RM,et al.Improving the quality of percutaneous revascularisation in patients with multivessel disease in Australia:cost-effectiveness,public health implications,and budget impact of FFR-guided PCI[J].Heart Lung Circ,2014,23(6):527-533.
[14]Zhang D,Lv S,Song X,et al.Fractional flow reserve versus angiography for guiding percutaneous coronaryintervention:a meta-analysis[J].Heart,2015,101(6):455-462.
[15]王明礼,刘建平,钟理,等.血流储备分数在多支血管病变患者中指导经皮冠状动脉介入治疗疗效的荟萃分析[J].重庆医学,2014,43(7):823-825.
[16]Engstr?m T,Kelb?k H,Helqvist S,et al.Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease(DANAMI-3-PRIMULTI):an open-label,randomised controlled trial[J].Lancet,2015,386(9994):665-671.