定量血流分数指导冠状动脉外科血运重建手术策略的研究

Study of quantitative flow ratio-guided surgical coronary artery revascularization strategy

目的探讨术前应用定量血流分数(QFR)评估冠状动脉功能性狭窄程度,指导冠状动脉旁路移植(CABG)血运重建策略的可行性。方法前瞻性纳入2019年1月至2020年9月期间在北京安贞医院心脏外科十一病房择期行单纯CABG的154例患者,对冠状动脉造影目测提示狭窄的病变血管进行QFR分析,获得病变血管功能性狭窄情况,外科医师术前对QFR分析结果不知情。收集患者基线资料、围手术期相关数据及近期临床结局并总结分析。结果1年后冠状动脉CTA显示,功能性显著病变(QFR<0.8)血管的旁路移植血管闭塞率为5.5%,非功能性显著病变(QFR≥0.8)血管的旁路移植血管闭塞率为15.6%。随访发现,心绞痛分级在发生与未发生旁路移植血管闭塞的患者间差异无统计学意义。结论依据QFR分析的功能性非显著病变的冠状动脉发生旁路移植血管闭塞的风险高于功能性显著病变血管,对于QFR提示阴性病变的冠状动脉,动脉旁路移植血管发生闭塞的风险比静脉旁路移植血管更高。这一发现与临床预后并无明显关联,非显著病变血管的旁路移植血管通畅或闭塞的患者均未发现过多心绞痛发作或冠状动脉重复干预的情况。QFR指导冠状动脉外科手术策略选择是安全可行的。

Objective To explore the feasibility of applying quantitative flow ratio(QFR)to assess the degree of coronary artery functional stenosis before surgery,and to guide coronary artery bypass grafting(CABG)revascularization strategy.Methods The study prospectively included a total of 154 patients who were electively treated with CABG in the 11th ward of the Department of Cardiac Surgery of Beijing Anzhen Hospital from January 2019 to September 2020,and their coronary angiography visually showed stenosis of the coronary artery to perform QFR analysis to know the diseased blood vessels.For functional stenosis,the surgeon was blinded to the results of QFR analysis before surgery.Collect its baseline data,perioperative data and recent clinical outcomes for summary analysis.Results One year later,the coronary artery CTA showed that the occlusion rate of functionally significant disease(QFR<0.8)was 5.5%,and that of non-functionally significant disease(QFR≥0.8)was 15.6%.There was no difference in angina class or repeat interventions between patients with or without occluded bypass grafts.Conclusion According to QFR analysis,coronary arteries with functional non-significant disease have a higher risk of grafts failure than those with functionally significant disease.For coronary arteries with negative QFR lesions,the risk of occlusion of arterial grafts is higher than that of venous.However,this finding is not significantly related to clinical prognosis,because patients with patency or occlusion of the grafts in non-significant lesions have not found excessive angina pectoris or repeated coronary interventions.QFR-guided selection of coronary surgery strategies is safe and feasible.