光学相干断层显像和血流储备分数指导处理冠脉中度狭窄病变对长期预后影响的比较

Comparison of the impact on long-term outcome of management of intermediate coronary stenosis under guidance of optical coherece tomography and fractional flow reserve

目的比较光学相干断层显像(OCT)和(FFR)指导处理冠脉中度狭窄病变(ICS)对长期预后的影响。方法选择2013年10月至2020年7月于首都医科大学附属北京友谊医院行冠脉造影结果为ICS并接受OCT或FFR指导处理的患者中符合标准的629例患者作为研究对象。根据指导病变处理的方式分为OCT组(n=155)和FFR组(n=474)。比较两组患者的一般临床资料、实验室和超声心动图检查结果、冠脉造影结果、FFR/OCT检查结果及经皮冠状动脉介入治疗(PCI)资料。通过log-rank检验比较OCT和FFR指导处理ICS对患者长期主要心脏不良事件(MACE)的影响,包括全因死亡、心肌梗死及再次血运重建。通过Cox回归分析研究影响患者长期MACE风险的相关因素。结果OCT组与FFR组相比,急性非ST段抬高性心肌梗死(NSTEMI)(25.8%vs.3.6%)、急性ST段抬高性心肌梗死(STEMI)(14.8%vs.1.5%)、陈旧性心肌梗死(12.9%vs.5.3%)、吸烟(56.1%vs.46.8%)患者比率及平均N末端B型钠尿肽前体(NT-proBNP)水平[(989.1±2922.2)pg/mL vs.(291.4±947.8)pg/mL]更高,而不稳定型心绞痛(52.9%vs.89.0%)、2型糖尿病(27.1%vs.38.2%)、卒中史(11.0%vs.18.1%)患者比率及左室射血分数(LVEF)[(63.2±7.8)%vs.(66.2±5.7)%]更低,差异均有统计学意义(P<0.05)。OCT组与FFR组相比,多支病变患者比率更低(48.4%vs.63.3%),而接受PCI治疗患者比率更高(54.2%vs.42.2%),差异均有统计学意义(P<0.05)。中位随访时间OCT组为33.8个月,FFR组为33.7个月。Log-rank检验结果显示,OCT组与FFR组累积MACE风险差异无统计学意义(P=0.645)。多因素Cox回归分析结果显示:左主干病变[HR=3.410,95%CI(1.570,7.404),P=0.002]、STEMI[HR=3.783,95%CI(1.684,8.496),P=0.001]、>65岁[HR=1.878,95%CI(1.060,3.327),P=0.031]增加长期MACE风险。结论应用FFR指导处理对ICS病变可以有效地降低接受PCI治疗患者比率,OCT和FFR指导处理ICS对患者长期MACE风险影响无统计学差异。

Objective To compare the impact on long-term outcome of management of intermediate coronary stenosis(ICS)under the guidance optical coherece tomography(OCT)and fractional flow reserve(FFR).Methods A total of 629 patients were selected according to the standard among the patients admitted to Beijng Friendship Hospital,Captital Medical University during Oct 2013 to July 2020 and having ICS according to coronary angiography being managed under the guidance of OCT or FFR,which were divided into OCT group(n=155)and FFR group(n=474).The general clinical data,laboratory and echocardiographic examination results,coronary angiography results,FFR/OCT examination results and percutaneous coronary intervention(PCI)data were compared between the two groups.Impact on major adverse cardiac events(MACE),including total death,myocardial infarction,and repeat revascularization of management of ICS under the guidance OCT and FFR was compared by log-rank test.Correlated factors of MACE were studied through Cox regression.Results Compared with the FFR group,the proportion of patients with acute non-ST-segment elevation myocardial infarction(NSTEMI)(25.8%vs.3.6%),acute ST-segment elevation myocardial infarction(STEMI)(14.8%vs.1.5%),old myocardial infarction(12.9%vs.5.3%),smoking(56.1%vs.46.8%),and the level of mean nitrogen-terminal natriuretic peptide(NT-pro BNP)[(989.1±2922.2)pg/mL vs.(291.4±947.8)pg/mL]in the OCT group was higher,the proportion of patients with unstable angina(52.9%vs.89.0%),type 2 diabetes(27.1%vs.38.2%),history of stroke(11.0%vs.18.1%)and left ventricular ejection fraction(LVEF)[(63.2±7.8)%vs.(66.2±5.7)%]in the OCT group were lower,and the differences were statistically significant(P<0.05).Compared with the FFR group,the proportion of patients with multivessel disease(48.4%vs.63.3%)was lower,receiving PCI(54.2%vs.42.2%)was higher in the OCT group,the differences were statistically significant(P<0.05).Median follow-up time were 33.8 months in OCT group and 33.7 months in FFR group.Log-rank test did not show statistical difference in accumulated hazard ratio of MACE between OCT group and FFR group(P=0.645).Multi-factor Cox regression analysis showed that left main disease[HR=3.410,95%CI(1.570,7.404),P=0.002],STEMI[HR=3.783,95%CI(1.684,8.496),P=0.001],and>65 years[HR=1.878,95%CI(1.060,3.327),P=0.031]increase the risk of MACE.Conclusion There were no statistical difference in the impact on long-term outcome of management of ICS under the guidance of OCT and FFR.