冠状动脉内支架术后心肌血流储备分数对心脏事件预测价值的研究

Predicting cardiac events with myocardial fractional flow resever (FFRmyo) after coronary stenting

目的 研究冠状动脉(冠脉)内支架术后即刻心肌血流储备分数(myocardialfractionalflowresever ,FFRmyo)对于术后3个月心脏事件的预测价值,并建立目标FFRmyo值。方法 2 0 0 3年7月至2 0 0 3年9月单支病变的冠脉内支架术后行冠脉内压力测定的连续79例稳定型心绞痛患者,术后临床随访3个月,随访主要心脏事件发生(包括死亡、心肌梗死、再次靶病变血运重建术以及再发心绞痛) ,并采用Logistic回归分析主要心脏事件发生的相关因素、冠心病危险因素及介入治疗中的相关参数。结果 76名患者完成了3个月的临床随访,有1 4名患者( 1 8 .4 % )发生了心脏不良事件,其中1 2名患者再发心绞痛( 1 5 .8% ) ,2名患者再次行经皮冠脉介入术( 2. 6 % )。Logistic回归分析显示:支架术后FFRmyo是术后3个月心脏事件的独立预测因子,其预测价值显著优于冠脉造影所判断的残余狭窄率。据ROC曲线判断FFRmyo的界值为0 . 92。结论 冠脉内支架术后即刻FFRmyo对于术后3个月心脏事件发生有独立的预测价值。

Objective To investigate the ability of myocardial fractional flow resever (FFRmyo) in predicting the incidence of major cardiac events (death, myocardial infarction, revascularization and recurrance of angina) 3 months after stent inplantation and also try to find out the cutoff point. Methods Coronary pressure was measured in 79 patients with stable angina immediately after stent implantation. The values of poststenting FFRmyo was calculated and found to be related to the presence of major adverse cardiac events during first 3 months. Results In 14 patients (18.4%), at least one adverse event occurred. Two out of 12 patients experienced recurrance of angina and underwent revascularization. By Logistic Regress analysis, FFRmyo immediately after stenting was the most significant independent variable for predicting major cardiac events. By receiver-operating characteristic (ROC) analysis, the cutoff point of FFRmyo was 0.92. Conclusion FFRmyo immediately after stenting is an independent predictor of clinical events at first 3 months.