基于造影的定量血流分数指导的功能性不完全血运重建及剩余功能性SYNTAX评分对多支病变对多支病变的冠心病患者预后影响

Prognostic implication of quantitative flow ratio-guide functional incomplete revascularization and residual functional SYNTAX score in patients with multi-vessels disease of coronary artery

目的探讨基于造影的定量血流分数(quantitative flow ratio,QFR)指导的功能性不完全血运重建(incomplete revascularization,IR)及剩余功能性SYNTAX评分(QFR-guide residual functional SYNTAX score,QrFSS)对多支病变患者长期预后的影响。方法回顾性纳入2016年1~12月于北京安贞医院明确诊断为冠心病且行冠状动脉介入治疗(percutaneous coronary intervention,PCI)的多支病变患者。分别计算SYNTAX评分、功能性SYNTAX评分(functional SYNTAX score,FSS)、剩余SYNTAX评分(residual SYNTAX score,r SS)及QrFSS,并进一步定义重大不良心血管事件(major adverse cardiac events,MACE),包括全因死亡率、再灌注治疗及心肌梗死。结果经Cox回归分析校正其他混杂因素影响后,功能性IR与患者长期MACE发生率明显相关(HR=2.460,95%CI 1.175~5.149,P=0.017)。此外在单因素分析中,作为连续性变量的QrFSS也与长期MACE发生率相关(HR=1.098,95%CI 1.005~1.200,P=0.039)。受试者工作者特征曲线证实,QrFSS可有力预测长期MACE的发生情况(曲线下面积0.635,95%CI 0.522~0.748,P=0.018)。结论QFR指导的功能性IR与多支病变患者长期不良预后紧密相关,也可通过QrFSS预测长期MACE事件的发生情况。

Objective To investigate the prognostic implication of quantitative flow ratio(QFR)-guide functional incomplete revascularization(IR)and residual functional SYNTAX score(Qr FSS)in patients with multi-vessels disease of coronary artery.Methods Coronary artery disease(CAD)patients with multi-vessels disease who underwent percutaneous coronary intervention(PCI)from January 2016 to December 2016 in Beijing Anzhen Hospital were enrolled.Subsequently,SYNTAX score,functional SYNTAX score(FSS),residual SYNTAX score(r SS)and Qr FSS were calculated by two experienced cardiologists.Additionally,the major adverse cardiac events(MACE)were defined as a composite of all-cause death,myocardial infarction and ischemia-driven revascularization at 2 years.Results After adjusting for other confounding factors with Cox regression analysis,functional IR was remain associated with a higher incidence of MACE(HR=2.460,95%CI1.175-5.149,P=0.017).In addition,Qr FSS,as a continuous variables,was also associated with the MACE incidence(HR=1.098,95%CI 1.005-1.200,P=0.039)in univariate analysis.Most importantly,the receiver operating characteristic(ROC)showed that Qr FSS could effectively predict the occurrence of long-term MACE(area under the curve 0.635,95%CI 0.522-0.748,P=0.018).Conclusion QFR-guided functional IR is closely related to the long-term poor prognosis of patients with multivessel disease of coronary arterty.In addition,Qr FSS could be used to predict the occurrence of long-term MACE.