OCT和FFR检测在优化左主干分叉病变介入治疗中的临床应用

Clinical Application of OCT and FFR Detection in Optimizing Interventional Treatment of Left Main Bifurcation Lesions

目的探讨光学干涉断层成像(OCT)和血流储备分数(FFR)检测技术在优化左主干分叉病变介入治疗中的临床应用价值。方法纳入2014年7月-2019年4月在该院诊断为冠状动脉左主干病变行介入治疗的65例患者作为研究对象。将其中接受冠状动脉造影(CAG)+OCT和(或)FFR检测+左主干支架植入术的患者纳入实验组20例;新入组的左主干分叉病变患者中不同意接受OCT和(或)FFR检测者纳入对照组45例。比较两组患者住院期间冠脉病变程度(包括病变血管数目、病变血管直径狭窄率)、支架植入数目、医疗费用、主要心脏不良事件(MACE)发生率的差异;再比较出院后随访期间,两组患者MACE发生率、6 min步行试验(6MWT)结果、再住院率的差异。结果实验组患者病变血管数目显著多于对照组,差异有统计学意义(t=2.527,P=0.023),但两组患者病变血管直径狭窄率和支架植入数目比较,差异无统计学意义(P>0.05)。实验组患者住院期间医疗费用为(4.80±1.29)万元,对照组患者住院期间医疗费用为(4.71±1.95)万元,实验组医疗费用高于对照组,但差异无统计学意义(t=0.189,P=0.832)。住院期间和随访期间实验组患者MACE发生率均低于对照组,但两组差异无统计学意义(P>0.05)。院后3个月、6个月时,实验组6MWT均显著大于对照组,差异有统计学意义(t=2.921、3.160,P=0.005、0.002)。随访6个月期间,实验组再住院率低于对照组,但两组差异无统计学意义(P>0.05)。结论与CAG+左主干支架植入比较,CAG+OCT和(或)FFR检测+左主干支架植入术有利于弥补影像学检查的不足,从而更准确地评估心脏血供情况,改善预后。

Objective To explore the clinical application value of optical interference tomography(OCT)and fractional blood flow reserve(FFR)in optimizing the interventional treatment of left main bifurcation lesions.Methods From July 2014 to April 2019,65 patients who were diagnosed with left main coronary artery disease and received interventional therapy in our hospital were included as the research objects.The patients who received coronary angiography(CAG)+OCT and(or)FFR detection+left main stent implantation was included in the experimental group of 20 cases;the newly enrolled patients with left main bifurcation disease did not agree to receive OCT and(or)FFR testers were included in the control group of 45 cases.Compare the differences in the degree of coronary artery disease(including the number of diseased vessels,the rate of stenosis of the diseased vessel diameter),the number of stent implants,medical expenses,and the incidence of major adverse cardiac events(MACE)during hospitalization between the two groups of patients;then compare the follow-up period after discharge,differences in the incidence of MACE,6-minute walk test(6MWT)results,and rehospitalization rates between the two groups.Results The number of diseased vessels in the experimental group was significantly more than that in the control group and the difference was statistically significant(t=2.527,P=0.023),but there was no statistically significant difference(P>0.05)between the two groups of patients in the diameter stenosis rate of diseased vessels and the number of stent implants.The medical expenses of the patients in the experimental group were(4.80±1.29)ten thousand during the hospitalization,and the medical expenses of the patients in the control group were(4.71±1.95)ten thousand during the hospitalization.The medical expenses of the experimental group were higher than those of the control group,but the difference was not statistically significant(t=0.189,P=0.832).During hospitalization and follow-up,the incidence of MACE in the experimental group was lower than that in the control group,but the difference between the two groups was not statistically significant(P>0.05).At 3 and 6 months after the hospital,the 6MWT of the experimental group was significantly greater than that of the control group(t=2.921、3.160,P=0.005、0.002).During the 6-month follow-up,the rehospitalization rate of the experimental group was lower than that of the control group,but the difference between the two groups was not statistically significant(P>0.05).Conclusion Compared with CAG+left main stent implantation,CAG+OCT and/or FFR detection+left main stent implantation is beneficial to make up for the lack of imaging examination,so as to more accurately assess the cardiac blood supply and improve the prognosis.