术后即刻FFR对PCI患者预后的预测价值

Prognostic value of FFR immediately after PCI for prognosis of PCI patients

目的探讨经皮冠状动脉介入治疗(PCI)术后即刻心肌血流储备分数(FFR)对患者预后的预测价值。方法纳入2014年3月—2017年12月在本院行PCI治疗的支架置入患者(200例)。术后进行1年随访(电话和门诊复查),根据随访期间有无发生主要心血管不良事件(MACE)将患者分为MACE组和非MACE组。进行单因素和多元Logistic回归分析PCI术后MACE影响因素,建立受试者工作特征曲线(ROC曲线)分析FFR的预测价值并绘制Kaplan-Meier曲线验证,分析术后FFR的影响因素。结果经过1年随访,MACE组31例,非MACE组169例。MACE组患者术后FFR显著低于非MACE组(t=6.316,P=0.000),MACE组糖尿病、高血压与高血脂患者的占比明显高于非MACE组(P<0.05)。多因素分析显示高血压、糖尿病、高血脂、术后FFR为MACE的影响因素。ROC曲线显示术后FFR对MACE有较好预测价值(P=0.000),其中术后FFR=0.868为最佳临界值。生存分析显示术后FFR≥0.868组患者MACE发生迟于术后FFR<0.868组(Log-rank P=0.008);多因素分析显示术后FFR影响因素有右侧冠状动脉靶血管累及、术前FFR值和支架直径(P=0.022,0.004,0.038,均<0.05)。结论术后FFR对PCI预后有较好预测价值,术后FFR≥0.868组患者MACE发生时间迟于术后FFR<0.868组。右侧冠状动脉靶血管累及、术前FFR值与支架直径是术后FFR的影响因素。

Aim To explore the predictive value of fractional flow reserve(FFR)immediately after percutaneous coronary intervention(PCI)on the prognosis of patients.Methods This study included patients(200 cases)who underwent PCI treatment in our hospital from March 2014 to December 2017.A 1-year follow-up(re-examination by telephone and outpatient)was carried out after the operation,and the patients were divided into MACE group and non-MACE group according to whether there were major adverse cardiovascular events(MACE)during the follow-up period.Perform univariate and multiple Logistic regression analysis to analyze the influencing factors of MACE after PCI,establish receiver operating characteristic curve(ROC curve)to analyze the predictive value of FFR and draw Kaplan-Meier curve to verifyit,and analyze the influencing factors of postoperative FFR.Results After 1 year of follow-up,31 cases were in the MACE group and 169 cases were in the non-MACE group.The postoperative FFR of MACE group was significantly lower than that of non-MACE group[t=6.316,P=0.000].The proportion of patients with diabetes,hypertension and hyperlipidemia in MACE group was significantly higher than that of non-MACE group(P<0.05).Multivariate analysis showed that hypertension,diabetes,hyperlipidemia,and postoperative FFR were the influencing factors of MACE.ROC curve showed that postoperative FFR had a better predictive value for MACE(P=0.000),and postoperative FFR=0.868 was the best critical value.Survival analysis showed that the incidence of MACE in the postoperative FFR≥0.868 group was later than that in the postoperative FFR<0.868 group(Log-rank P=0.008);multivariate analysis showed that postoperative FFR influencing factors included right coronary target vessel involvement and preoperative FFR value and stent diameter(P=0.022,0.004,0.038,all P<0.05).Conclusions Postoperative FFR has a good predictive value for the prognosis of PCI.The incidence of MACE in the postoperative FFR≥0.868 group is later than that in the postoperative FFR<0.868 group.Involvement of the right coronary target vessel,preoperative FFR value and stent diameter are the influencing factors of postoperative FFR.