冠状动脉造影与血流储备分数指导下边支介入治疗对冠状动脉分叉病变患者影响的对比研究

Comparative Study for Impact on Coronary Bifurcation Lesion between CAG and FFR Guided PCI for Side Branch

目的比较冠状动脉造影(CAG)与血流储备分数(FFR)指导下边支介入治疗对冠状动脉分叉病变患者的影响。方法选取2013年4月—2014年9月在东莞市第三人民医院就诊的冠状动脉分叉病变患者86例,随机分为A组和B组,每组43例。A组患者在CAG指导下进行边支介入治疗,而B组患者在FFR指导下进行边支介入治疗。比较B组患者手术前后FFR,两组患者行支架置入术者所占比例、置入支架数量、支架长度、手术时间及住院时间;记录随访6个月、12个月及2年不良心血管事件发生情况。结果 B组患者术后FFR高于术前(P<0.05)。B组患者行支架置入术者所占比例低于A组,置入支架数量少于A组,支架长度短于A组(P<0.05),而两组患者手术时间及住院时间比较,差异无统计学意义(P>0.05)。随访6、12个月时两组患者病死率及支架内血栓形成、心肌梗死、心绞痛发生率比较,差异无统计学意义(P>0.05);随访2年时两组患者病死率及心肌梗死、心绞痛发生率比较,差异无统计学意义(P>0.05),而B组患者支架内血栓形成发生率低于A组(P<0.05)。结论与CAG指导下边支介入治疗相比,FFR指导下边支介入治疗能更好地降低冠状动脉分叉病变患者行支架置入术必要性、减少置入支架数量、缩短支架长度,且有利于降低长期支架内血栓形成发生率。

Objective To compare the impact on coronary bifurcation lesion between CAG and FFR guided PCI for side branch. Methods A total of 86 patients with coronary bifurcation lesion were selected in the Third People’ s Hospital of Dongguan from April 2013 to September 2014, and they were randomly divided into A group and B group, each of 43 cases. Patients of A group received CAG guided PCI for side branch,while patients of B group received FFR guided PCI for side branch. FFR of B group before and after surgery were compared,proportion of patients undergoing stent implantation,number and length of implanted stents,duration of surgery and hospital stays were compared between the two groups,and incidence of adverse cardiovascular events during the 6- month,12- month and 2- year follow- up was recorded. Results After surgery,FFR of B group was statistically significantly higher than that before surgery（ P 〈 0. 05）. Proportion of patients undergoing stent implantation of B group was statistically significantly lower than that of A group, number of implanted stents of B group was statistically significantly less than that of A group,length of implanted stents of B group was statistically significantly shorter than that of A group（ P 〈 0. 05）, while no statistically significant differences of duration of surgery or hospital stays was found between the two groups（ P 〉 0. 05）. During the 6- month or 12- month,no statistically significant differences of fatality rate,incidence of intra- stent thrombosis,myocardial infarction or angina pectoris was found between the two groups（ P 〉 0. 05）;during the 2- year follow- up,no statistically significant differences of fatality rate,incidence of myocardial infarction or angina pectoris was found between the two groups（ P 〉 0. 05）,while incidence of intra- stent thrombosis of B group was statistically significantly lower than that of A group（ P 〈 0. 05）. Conclusion Compared with CAG guided PCI for side branch,FFR guided PCI for side branch can preferably reduce the necessity of stent implantation and number of implanted stents,shorten the length of implanted stents,thus is helpful to reduce the long- term risk of intra- stent thrombosis.