FFR指导下功能性完全血运重建对NSTEMI并发多支病变患者短期预后影响

Prognostic impact of functionally completely revascularization guided by fractional flow reserve in patients with non ST-elevation myocardial infarction and multivessel disease

目的评价血流储备分数(FFR)指导下功能性完全血运重建对非ST段抬高型心肌梗死(NSTEMI)并发多支病变患者短期预后的影响。方法选取西京医院心血管内科95例NSTEMI并发多支病变患者为功能性完全血运重建组(冠脉造影狭窄>90%的病变直接行PCI治疗,对狭窄70%~90%的病变行FFR检查,FFR<0.75为PCI治疗的指征),同时期冠脉造影指导下完全血运重建的患者为对照(解剖学完全血运重运组)组(狭窄≥70%且直径>2.5 mm的病变常规行PCI治疗)。患者随访12个月,比较两组患者主要不良心血管事件(MACE)及再发心绞痛、因冠心病再住院发生情况和左室射血分数(LVEF)的变化。结果与对照组比较,功能性完全血运重建组再发心绞痛[9%vs.30%,P<0.01]、因冠心病再住院[5%vs.19%,P<0.01]及MACE[9%vs.22%,P<0.05]发生率均显著降低;两组LVEF均较术前增加[(60±7)%vs.(56±8)%],功能性完全血运重建组增加显著(均P<0.05)。结论 FFR指导下功能性完全血运重建能降低患者12个月MACE发生率,减少再发心绞痛、因冠心病再住院次数,改善患者左心功能,患者近期获益明显。

AIM To evaluate the prognotic influence of functional completely revascularization guided by fractional flow reserve （FFR） in patients with non ST-elevation myocardial infarction and multivessel disease. METHODS 95 cases of patients with non ST-elevation myocardial infarction （NSTEMI） and multivessel disease were chosen as the functional completely revascularization group. Same period reascularization patients served as the control group. Patients were followed up for 12 months, the incidence of major adverse cardiac events （MACE） and changes in left ventricular ejection fraction were compared. RESULTS Compared with the control group, the functional completely revascularization group had a lower incidence in recurrence angina, coronary heart disease hospital again and MACE （P〈0.05）. Both of the two groups had an increased LVEF, which was more significantly increased in the functional completely reascularization group （P〈0.05）. CONCLUSION Functional completely revascularization guided by FFR reduces the incidence of MACE at one year, the number of angina pectoris and coronary heart disease hospital readmission, and improves left cardiac function of patients.