血流储备分数在合并糖尿病的不稳定心绞痛和非ST段抬高型心梗的患者PCI中的运用

Patients with DM Suffering from Unstable Angina or Non-STEMI could Benefit More from FFR Application

目的本研究拟对合并糖尿病的UA或NSTEMI的患者使用FFR导丝指导PCI术的获益情况进行分析。方法 80例合并糖尿病的UA或NSTEMI患者随机分配至FFR和单纯血管造影组,分别比较PCI手术治疗情况(包括手术时间、适合植入支架的病灶数、植入支架数量、糖蛋白IIb/IIIa受体拮抗剂使用率和住院时间)和随访1年后的心血管不良反应事件。结果 FFR导丝指导PCI组患者手术时间较血管造影组少3分钟,但无统计学差异(62±31 vs 65±23,p=0.703),适合植入支架的病灶数较少(2.3±0.8 vs 2.7±0.7,p=0.024)、植入支架少(1.9±1.1 vs 2.5±1.3,P<0.01)、糖蛋白IIb/IIIa受体拮抗剂使用率减少(45%vs 55%,p=0.03)、住院时间缩短(4.8±2.5 vs 5.9±2.2,p=0.012)。术后随访1年,FFR组和血管造影组不良反应事件无明显差异:FFR组患者因各种原因进行再次PCI以及冠脉搭桥术比例(13%vs 15%,p=0.675)、发生心肌梗死的比例(5%vs 10%,p=0.071)以及心绞痛发作的比例(30%vs 38%,p=0.064)均较血管造影组要少,但均无显著差异。心功能评级无显著差异。结论 FFR指导合并糖尿病的UA或NSTEMI患者进行PCI成本效益明显优于仅根据血管造影结果指导PCI。

Objective The purpose of the study was to determine whether patients with DM suffering from unstable angina（UA） or nonSTEMI could benefit from Fractional Flow Reserve（FFR） application. Methods 80 patients with DM suffering from UA or non-STEMI was randomly divided into two groups, one as FFR treated, the other as regular treated. The operation treatment and outcome of follow up in one year were compared, including operation time, the number of lesion fit for percutaneous coronary intervention（PCI）,the stent number, usage of Glycoprotein IIb / IIIa receptor antagonists, length of hospital stay and outcome of one year follow up. Results PCI with help of FFR had some advantages. Alough there was no no statistical difference, less 3 mins of operation time could be watched（62±31 vs 65±23,p=0.703）;the number of lesion fit for PCI with FFR or not was 2.3±0.8 vs 2.7±0.7, p=0.024;the stent number in two groups was 1.9±1.1 vs 2.5±1.3, P0.01; usage of Glycoprotein IIb / IIIa receptor antagonists was 45% vs 55%, p=0.03; length of hospital stay was 4.8±2.5 vs 5.9±2.2, p=0.012.The outcome of one-year follow up in with FFR or not with FFR groups was revascularization as 13% vs 15%, p=0.675,MI as 5% vs 10%, p=0.071,angina as 30% vs 38%, p=0.064,respectively.And there was no difference in heart function in these two groups. Conclusion Our results support patients with DM suffering from UA or non-STEMI could benefit more from FFR application.