FFR联合CAG对冠心病患者PCI术后主要不良心脏事件发生的评估

Evaluation of FFR combined with CAG on major adverse cardiac events in patients with coronary artery disease after PCI

目的评估冠状动脉造影（CAG）联合血流储备分数（FFR）对冠状动脉粥样硬化性心脏病（冠心病）患者经皮冠状动脉介入治疗（PCI）后12个月主要不良心脏事件（MACE）发生。方法收集2014年4月-2015年3月于泰州第二人民医院收治的冠心病并接受PCI患者127例,根据术后12个月是否发生MACE分为两组,即MACE组和非MACE组,记录两组的临床资料,如性别、年龄、吸烟史、并发症（高血压病、糖尿病、高脂血症）、出院用药情况、CAG评价的冠状动脉病变相关参数（病变部位、病变血管支数、血管狭窄程度）和FFR值,并进行Logistic回归分析评估发生MACE的危险因素。结果纳入冠心病并接受PCI术的患者127例,男性80例（63.0%）,女性47例（37.0%）;年龄为64.8±9.5岁;体质指数23.0±2.4 km/m2;NYHA心功能分级Ⅱ-Ⅲ111例（87.4%）,Ⅳ16例（12.6%）;合并糖尿病史65例（51.2%）、高血压史71例（55.9%）和高血脂史89例（70.1%）;有吸烟者74例（58.3%）;CAG评价的血管狭窄度为（96.1±4.0）%;FFR为0.97±0.06。单因素分析显示,MACE组与非MACE组性别、年龄、体质指数、NYHA心功能分级、病变部位、病变血管支数、吸烟史和出院用药情况组间比较差异无统计学意义（P〉0.05）。Logistic回归分析显示PCI术后12个月发生MACE的危险因素有FFR、高血脂史和糖尿病史（P〈0.05）。结论影响PCI术后12个月发生MACE的因素有低水平的FFR、高血脂史和糖尿病史,单纯通过CAG评价冠状动脉狭窄程度并不能预测MACE发生,可增加FFR检测。

Objective To evaluate coronary arteriography（CAG） combined with fractional flow reserve（FFR） on major adverse cardiac events（MACE） in patients with coronary artery disease（CHD） 12 months after received percutaneous coronary intervention（PCI）. Methods From April 2014 to March 2015, 127 CHD patients in Taizhou Second People＇s Hospital were enrolled. They were divided into 2 groups 12 months after received PCI： MACE group and Non-MACE group. Clinical data were recorded, including sex, age, smoking history, complications（hypertension, diabetes mellitus, hyperlipidemia）, hospital discharge, CAG parameters（lesion site, vessel diameter and degree of stenosis） and FFR. Logistic regression analysis was performed to assess risk factors for MACE. Results There were 80 males（63.0%） and 47 females（37.0%）. The average age was 64.8±9.5 years old. The average body mass index was 23.0±2.4 km/m2. 111（87.4%） patients were classified in Ⅱ-Ⅲ grade of NYHA heart function classification and 16 patients were classified as IV grade（12.6%）. 65 patients（51.2%） had history of diabetes mellitus, 71 patients（55.9%） had hypertension history, 89 patients（70.1%） had hyperlipidemia history and 74 patients（58.3%） had smoke history. The average stenosis degree of CAG was（96.1±4.0） %; the average FFR was 0.97±0.06. Result of univariate analysis showed that there was no significant difference between MACE group and non-MACE group in gender, age, body mass index, NYHA cardiac function grade, lesion site, vessel count, smoking history and hospital discharge（P〈0.05）. Result of logistic regression analysis showed that risk factors of MACE were FFR, hyperlipidemia and diabetes mellitus at 12 months after PCI（P〈0.05）. Conclusion The factors that affected MACE at 12 months after PCI were low levels of FFR, hyperlipidemia, and diabetes. The severity of coronary artery stenosis assessed by CAG alone did not predict MACE. It is suggested that FFR should be also detected.