冠状动脉血流储备分数联合冠状动脉造影对冠心病慢性心肌缺血患者治疗策略的指导价值

Guidance Value of Coronary Fractional Flow Reserve Combined with Coronary Angiography for Treatment Strategies for Patients with Coronary Heart Disease and Chronic Myocardial Ischemia

目的分析冠状动脉血流储备分数(FFR)联合冠状动脉造影(CAG)对冠心病慢性心肌缺血(CMI)患者治疗策略的指导价值。方法选取2017年10月至2018年10月保定第七医院心内科收治的140例经CAG检查达到临界病变的CMI患者为研究对象,采用随机数字法分为观察组和对照组,各70例。对照组根据CAG结果采用介入治疗,观察组依据CAG联合FFR结果采用选择性介入治疗。比较两组介入治疗情况、住院时间及住院费用,随访13个月观察两组心脏不良事件发生率。结果观察组支架置入比例、直径狭窄百分比、面积狭窄百分比小于对照组[75.71%(53/70)比100.00%(70/70)、(52.29±10.65)%比(56.13±10.74)%、(70.43±10.93)%比(74.26±9.74)%](P<0.05或P<0.01),最小管腔直径大于对照组[(1.38±0.49)mm比(1.06±0.54)mm](P<0.01)。观察组住院时间短于对照组[(6.29±0.65)d比(7.13±0.74)d](P<0.01),住院费用少于对照组[(4.86±0.49)万元比(5.06±0.54)万元](P<0.05)。观察组术后心肌梗死、血运重建、心绞痛及总不良事件发生率低于对照组[0比8.57%(6/70),0比8.57%(6/70),1.43%(1/70)比11.43%(8/70),7.14%(5/70)比31.43%(22/70)](P<0.05)。结论FFR联合CAG能够减少缺血相关靶病变个数,避免无效的经皮冠状动脉介入,提高CMI患者经皮冠状动脉介入治疗效果,降低心脏不良事件发生风险。

Objective To analyze the guidance value of coronary fractional flow reserve(FFR)combined with coronary angiography(CAG)for treatment strategies for patients with coronary heart disease and chronic myocardial ischemia(CMI).Methods A total of 140 CMI patients who were confirmed with critical lesions by CAG and admitted to Cardiology Department of Baoding Seventh Hospital from Oct.2017 to Oct.2018 were enrolled as study objects.They were divided into an observation group and a control group by random number method,70 cases in each group.The control group underwent intervention therapy based on CAG results,while the observation group underwent elective intervention therapy based on CAG and FFR.The intervention treatment conditions,hospitalization time and cost were compared between the two groups.Both groups were followed up for 13 months to observe the incidence of adverse cardiac events.Results The proportion of stent placement,the percentage of diameter stenosis and the percentage of area stenosis in the observation group were smaller than those in the control group[75.71%(53/70)vs 100.00%(70/70),(52.29±10.65)%vs(56.13±10.74)%,(70.43±10.93)%vs(74.26±9.74)%](P<0.05 or P<0.01),minimum lumen diameter was greater than that of the control group[(1.38±0.49)mm vs(1.06±0.54)mm](P<0.01).The hospitalization time of the observation group was shorter than that of the control group[(6.29±0.65)d vs(7.13±0.74)d](P<0.01),the medical cost was less than that of the control group[(48600±4900)yuan vs(50600±5400)yuan](P<0.05).The incidences of myocardial infarction,revascularization,angina pectoris and total adverse events in the observation group were lower than those in the control group[0 vs 8.57%(6/70),0 vs 8.57%(6/70),1.43%(1/70)vs 11.43%(8/70),7.14%(5/70)vs 31.43%(22/70)](P<0.05).Conclusion FFR combined with CAG can reduce number of ischemia-related targeted lesions,avoid invalid percutaneous coronary intervention,improve curative effect of percutaneous coronary intervention therapy on CMI patients,and decrease the risk of adverse cardiac events.