QFR指导STEMI合并多支血管病变患者非梗死相关血管血运重建的成本效益分析

Cost-Efficient Analysis for Quantitative Flow Ratio-Guided Non-Infarct Related Vessel Revascularization in STEMI Patients with Multi-Vessel Disease

目的分析定量血流分数(QFR)指导急性ST段抬高型心肌梗死(STEMI)合并多支血管病变患者非梗死相关血管血运重建的手术耗费和临床获益。方法回顾性收集2019年1月—2020年12月急诊行经皮冠状动脉介入治疗(PCI)且合并多支血管病变的159例STEMI患者,根据是否采用QFR指导非梗死相关血管PCI分为QFR指导组和造影指导组,比较两组处理非梗死相关血管的例均手术器械消耗和手术花费、1 a无净不良临床事件(NACE,定义为1 a全因死亡、再发心肌梗死、所有再次血运重建、因心力衰竭住院、卒中、严重出血的累积事件)和无主要不良心血管事件(MACE,定义为1 a心脏性死亡、再发心肌梗死、缺血驱动血运重建的累积事件)生存率。结果QFR指导组所使用的指引导管、指引导丝、预扩张球囊、后扩张球囊及支架总数分别为(0.86±0.35)根、(0.97±0.51)条、(0.74±0.55)个、(0.86±0.55)个和(1.12±0.68)枚,明显少于造影指导组[(1.01±0.11)根,P<0.001]、[(1.12±0.33)条,P=0.029]、[(0.90±0.49)个,P=0.041]、[(1.11±0.57)个,P=0.005]和[(1.33±0.59)枚,P=0.033];QFR指导组的手术费用较造影指导组减少近16.5%[(2.60±0.26)万元vs(2.17±0.91)万元,P<0.001];QFR指导组累积1 a无NACE和无MACE生存率分别为91.0%和93.6%,略优于造影指导组的86.4%和91.4%,差别无统计学意义(P>0.05)。结论QFR指导的非梗死相关血管血运重建策略的手术耗费更低,但临床获益与造影指导的非梗死相关血管血运重建策略类似。

Objective To analyze the procedural consumption and clinical benefit of quantitative flow ratio(QFR)-guided non-infarct related vessel revascularization in ST-segment elevation myocardial infarction(STEMI)patients with multi-vessel disease.Methods One hundred and fifty-nine patients with STEMI complicated with mulit-vessel disease who underwent emergency percutaneous coronary intervention(PCI)from January 2019 to December 2020 were retrospectively collected.According to whether QFR was used to guide PCI for non-infarct related vessels,they were divided into QFR-guided group and angiography-guided group.The consumption of procedural devices and procedural expenses per case and the cumulative 1-year NACE-free(NACE,i.e.,net adverse clinical events defined as 1-year cumulative events of all-cause death,recurrent myocardial infarction,all revascularization,hospitalization for heart failure,stroke and major bleeding)and 1-year MACE-free(MACE,i.e.,major adverse cardiovascular events defined as 1-year cumulative events of cardiac death,recurrent myocardial infarction,ischemia-driven revascularization)survival rates were compared between the two groups.Results The number of guiding catheter,guiding wire,pre-dilation balloon,post-dilation balloon and stent used in QFR-guided group were(0.86±0.35),(0.97±0.51),(0.74±0.55),(0.86±0.55),and(1.12±0.68),respectively,which were significantly less than those of angiography-guided group[(1.01±0.11),P<0.001],[(1.12±0.33),P=0.029],[(0.90±0.49),P=0.041],[(1.11±0.57),P=0.005],and[(1.33±0.59),P=0.033],respectively.The procedural expense of the QFR-guided group was nearly 16.5%lower than the angiography-guided group[(26000±2600)￥vs(21700±9100)￥,P<0.001].The cumulative 1-year NACE-free and MACE-free survival rates in the QFR-guided group were 91.0%and 93.6%,respectively,which were slightly better than those in the angiography-guided group(86.4%and 91.4%)with no significant difference(P>0.05).Conclusion QFR guided non-infarct related vessel revascularization has lower procedural cost,but the clinical benefit is similar to that of contrast-guided non-infarct related vessel revascularization.