冠状动脉内支架术后心肌血流储备分数预测心脏事件的研究
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摘要
目的 研究冠状动脉内支架术后即刻心肌血流储备分数(FFRmyo)对术后6个月主要不良心脏事件(MACE)的预测价值,并建立FFRmyo的界定值。
方法 2003年7月至2003年9月在我院住院的稳定性心绞痛患者中,连续入选79例单支冠状动脉病变患者,分别于冠状动脉内支架术前及术后即刻测定FFRmyo和定量冠状动脉造影(QCA)诸参数,术后临床随访6个月,随访主要不良心脏事件率(包括死亡、心肌梗死、再次靶病变血运重建以及再发心绞痛),并采用多元logistic回归分析主要不良心脏事件发生率与冠心病危险因素、FFRmyo及QCA诸参数之间的关系。
结果 76例患者完成了6个月的临床随访,有14例患者(18.4%)发生了主要不良心脏事件,其中10例再发心绞痛(13.1%),4例需再次行经皮冠脉介入术(5.3%);多元logistic回归分析显示:支架术后FFRmyo是术后6个月主要不良心脏事件的独立预测因子(P=0.004),其预测价值显著优于QCA测定的残余狭窄(RS);据ROC曲线得出FFRmyo的界定值为0.92。
结论 冠状动脉内支架术后即刻FFRmyo是判定术后6个月主要心脏不良事件的独立预测因子。
Objective To determine the predictive value of myocardial fractional flow reserve (FFRmyo) on major adverse cardiac events (MACE) in patients with stable angina after coronary artery stenting.Methods Of patients with stable angina admitted to our department from July 2003 to September 2003, 79 patients with single vessel disease were enrolled into the present study. FFRmyo and angiographic findings by quantity coronary angiography (QCA) were calculated before and immediately after coronary artery stenting. Incidence of MACE was recorded during 6 months follow-up. Multistep logistic regression analysis was managed to determine coronary risk factors, FFRmyo and indexes by QCA.Results Of 79 patients, 76 patients completed clinical follow-up within 6 months. MACE was identified in 14 patients (18.4%), 10 of 14 patients experienced re-angina (13.1%), revascularization of target segment was needed in 4 patients (5.3%). By multistep logistic regress analysis, FFRmyo
方法 2003年7月至2003年9月在我院住院的稳定性心绞痛患者中,连续入选79例单支冠状动脉病变患者,分别于冠状动脉内支架术前及术后即刻测定FFRmyo和定量冠状动脉造影(QCA)诸参数,术后临床随访6个月,随访主要不良心脏事件率(包括死亡、心肌梗死、再次靶病变血运重建以及再发心绞痛),并采用多元logistic回归分析主要不良心脏事件发生率与冠心病危险因素、FFRmyo及QCA诸参数之间的关系。
结果 76例患者完成了6个月的临床随访,有14例患者(18.4%)发生了主要不良心脏事件,其中10例再发心绞痛(13.1%),4例需再次行经皮冠脉介入术(5.3%);多元logistic回归分析显示:支架术后FFRmyo是术后6个月主要不良心脏事件的独立预测因子(P=0.004),其预测价值显著优于QCA测定的残余狭窄(RS);据ROC曲线得出FFRmyo的界定值为0.92。
结论 冠状动脉内支架术后即刻FFRmyo是判定术后6个月主要心脏不良事件的独立预测因子。
Objective To determine the predictive value of myocardial fractional flow reserve (FFRmyo) on major adverse cardiac events (MACE) in patients with stable angina after coronary artery stenting.Methods Of patients with stable angina admitted to our department from July 2003 to September 2003, 79 patients with single vessel disease were enrolled into the present study. FFRmyo and angiographic findings by quantity coronary angiography (QCA) were calculated before and immediately after coronary artery stenting. Incidence of MACE was recorded during 6 months follow-up. Multistep logistic regression analysis was managed to determine coronary risk factors, FFRmyo and indexes by QCA.Results Of 79 patients, 76 patients completed clinical follow-up within 6 months. MACE was identified in 14 patients (18.4%), 10 of 14 patients experienced re-angina (13.1%), revascularization of target segment was needed in 4 patients (5.3%). By multistep logistic regress analysis, FFRmyo
引文
1. Nissen SE, Guley JC. Assessment of the functional significance of coronary stenosis: is digital angiography the answer? Circulation 1990; 81: 1431-1435.
2. Topol EJ, Nissen SE. Our preoccupation with coronary luminology: the dissociation between clinical and angiographic findings in ischemic heart disease. Circulation 1995; 92: 2333-2342.
3. Kern JM, De Bruyne B, Pijls NHJ. From research to clinical practice: current role of intracoronary physiologically based decision making in the cardiac cathererization laboratory. J Am CollCardiol 1997; 30: 613-620.
4. Pijls NHJ, Van Gelder B, Van der Voort P, et al. Fractional flow reserve: a useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation 1995; 92: 3183-3193.
5. Pijls NHJ, De Bruyne B, Peels K, et al. Measurement of fractional flow reserve to assess the functional severity of coronary artery stenoses. N Engl J Med 1996; 334: 1703-1708.
6. Wilson RF. Assessing the severity of coronary artery stenoses. N Engl J Med 1996; 334: 1735-1737.
7. Pijls NHJ, van Son JAM, Kirkeeide RL, et al. Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after PTCA. Circulation 1993;87:1354-1367.
8. De Bruyne B, Bartunek J, Sys SK, et al. Simultaneous coronary pressure and flow velocity measurements in humans. Circulation 1996;94:1842-1849.
9. Pijls NHJ, Bech GJW, Gamal MIH, et al. Quantification of recruitable coronary collateral blood flow in conscious humans and its potential to predict future ischemic events.J Am Coll Cardiol 1995;25:1522-1528.
10.De Bruyne B, Bartunek J, Sys SU, et al. Relation between myocardial fractional flow reserve calculated from coronary pressure measurements and exercise-induced myocardial ischemia. Circulation 1995;92:39-46.
11 .Bartunek J, Marwick Th, Rodriques ACT, et al. Dobutamine induced wall motion abnormalities: correlations with myocardial fractional flow reserve and quantitavive coronary angiography. J Am Coll Cardiol 1996;27:1429-1436.
12.Bech GJW,De Bruyne B,Bonnier H JRM, et al. Long term follow up after deferral of percutaneous transluminal coronary angioplasty of intermediate stenosis on the basis of coronary pressure measure . J Am Coll Cardiol 1998;31:841-847.
13.Steven AJC,Martijn M,Karel TK,et al.Usefulness of fractional flow reserve for risk stratification of patients with multivessel coronary artery disease and an intermediate stenosis.Am J Cardiol 2002;89:377-380.
14.Pijls NHJ, Bech GJW, De Bruyne B, et al. Prognostic value of pressure-derived fractional flow reserve to predict restenosis after regular ballon angioplasty [abstract]. Circulation 1997;96:I-649.
15.Hanekamp C, Koolen JJ, Pijls NHJ, et al. Comparison of quantitative coronary angiography, mtravascular ultrasound,and pressure-derived fractional flow reserve to assess optimal stent deployment. Circulation 1999, 99:1015-1021.
16.Bech GJW,Pijls NHJ,De Bruyne B,et al. Usefulness of fractional flow reserve to predict clinical outcome after balloon angioplasty. Circulation 1999;99:883-888.
17.Koning R, Eltchaninoff H, Commeau P, et al. Stent placement compared with balloon angioplasty in small coronary arteries. Circulation 2001;104:1604-1608.
18.Mudra H, Di Mario C, De Jaegere P, et al. Randomized comparison of coronary stent implantation under ultrasound or angiographic guidance to reduce stent restenosis (OPTICUS study). Circulation 2001;104:1343-1349.
19.Kasaoka S, Tobis J, Akiyama T, et al.Angiographic and intravascular ultrasound predictors of in-stent restenosis. J Am Coll Cardiol
2. Topol EJ, Nissen SE. Our preoccupation with coronary luminology: the dissociation between clinical and angiographic findings in ischemic heart disease. Circulation 1995; 92: 2333-2342.
3. Kern JM, De Bruyne B, Pijls NHJ. From research to clinical practice: current role of intracoronary physiologically based decision making in the cardiac cathererization laboratory. J Am CollCardiol 1997; 30: 613-620.
4. Pijls NHJ, Van Gelder B, Van der Voort P, et al. Fractional flow reserve: a useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation 1995; 92: 3183-3193.
5. Pijls NHJ, De Bruyne B, Peels K, et al. Measurement of fractional flow reserve to assess the functional severity of coronary artery stenoses. N Engl J Med 1996; 334: 1703-1708.
6. Wilson RF. Assessing the severity of coronary artery stenoses. N Engl J Med 1996; 334: 1735-1737.
7. Pijls NHJ, van Son JAM, Kirkeeide RL, et al. Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after PTCA. Circulation 1993;87:1354-1367.
8. De Bruyne B, Bartunek J, Sys SK, et al. Simultaneous coronary pressure and flow velocity measurements in humans. Circulation 1996;94:1842-1849.
9. Pijls NHJ, Bech GJW, Gamal MIH, et al. Quantification of recruitable coronary collateral blood flow in conscious humans and its potential to predict future ischemic events.J Am Coll Cardiol 1995;25:1522-1528.
10.De Bruyne B, Bartunek J, Sys SU, et al. Relation between myocardial fractional flow reserve calculated from coronary pressure measurements and exercise-induced myocardial ischemia. Circulation 1995;92:39-46.
11 .Bartunek J, Marwick Th, Rodriques ACT, et al. Dobutamine induced wall motion abnormalities: correlations with myocardial fractional flow reserve and quantitavive coronary angiography. J Am Coll Cardiol 1996;27:1429-1436.
12.Bech GJW,De Bruyne B,Bonnier H JRM, et al. Long term follow up after deferral of percutaneous transluminal coronary angioplasty of intermediate stenosis on the basis of coronary pressure measure . J Am Coll Cardiol 1998;31:841-847.
13.Steven AJC,Martijn M,Karel TK,et al.Usefulness of fractional flow reserve for risk stratification of patients with multivessel coronary artery disease and an intermediate stenosis.Am J Cardiol 2002;89:377-380.
14.Pijls NHJ, Bech GJW, De Bruyne B, et al. Prognostic value of pressure-derived fractional flow reserve to predict restenosis after regular ballon angioplasty [abstract]. Circulation 1997;96:I-649.
15.Hanekamp C, Koolen JJ, Pijls NHJ, et al. Comparison of quantitative coronary angiography, mtravascular ultrasound,and pressure-derived fractional flow reserve to assess optimal stent deployment. Circulation 1999, 99:1015-1021.
16.Bech GJW,Pijls NHJ,De Bruyne B,et al. Usefulness of fractional flow reserve to predict clinical outcome after balloon angioplasty. Circulation 1999;99:883-888.
17.Koning R, Eltchaninoff H, Commeau P, et al. Stent placement compared with balloon angioplasty in small coronary arteries. Circulation 2001;104:1604-1608.
18.Mudra H, Di Mario C, De Jaegere P, et al. Randomized comparison of coronary stent implantation under ultrasound or angiographic guidance to reduce stent restenosis (OPTICUS study). Circulation 2001;104:1343-1349.
19.Kasaoka S, Tobis J, Akiyama T, et al.Angiographic and intravascular ultrasound predictors of in-stent restenosis. J Am Coll Cardiol