血流储备分数在急性ST段抬高型心肌梗死合并多支病变患者急诊经皮冠状动脉介入治疗中的应用

Application of fractional flow reserve in primary percutaneous coronary intervention for patients with acute ST-segment elevation myocardial infarction complicated with multivessel disease

目的探讨血流储备分数(FFR)在急性ST段抬高型心肌梗死(STEMI)合并多支病变患者急诊经皮冠状动脉介入(PCI)治疗中的应用价值。方法入选2018年2月至2019年8月首都医科大学附属北京友谊医院平谷医院及首都医科大学附属北京安贞医院STEMI合并多支病变并已行梗死相关血管急诊PCI治疗患者101例。按随机数字表法将患者分为2组,一组以FFR为指导,根据FFR处理非梗死相关血管完成完全血运重建(完全血运重建组,48例);另一组以冠状动脉造影为指导,在急性期仅处理梗死相关血管(仅处理梗死相关血管组,53例)。比较2组患者PCI相关指标和术后随访心脑血管事件发生情况。主要终点为随访12个月时全因死亡、非致死性心肌梗死、再次血运重建和脑血管事件。结果完全血运重建组手术操作时间长于仅处理梗死相关血管组[(65±11)min比(59±8)min],支架总长短于仅处理梗死相关血管组[(31±10)mm比(36±10)mm],差异均有统计学意义(均P<0.05)。完全血运重建组在FFR指导下行非梗死相关血管PCI处理26例(54.2%)。完全血运重建组随访12个月时心绞痛、再次血运重建和主要终点事件发生率均低于仅处理梗死相关血管组[4.2%(2/48)比18.9%(10/53)、6.2%(3/48)比22.6%(12/53)、8.3%(4/48)比24.5%(13/53)],差异均有统计学意义(均P<0.05)。结论对于STEMI合并多支病变并已行梗死相关血管急诊PCI治疗患者,急性期在FFR指导下对非梗死相关血管进行完全血运重建,比仅进行梗死相关血管PCI降低了心脑血管事件的发生风险。

Objective To explore the application value of fractional flow reserve(FFR)in primary percutaneous coronary intervention(PCI)for patients with acute ST-segment elevation myocardial infarction(STEMI)complicated with multivessel disease.Methods From February 2018 to August 2019,totally 101 STEMI patients with multivessel disease undergoing primary PCI were selected from Pinggu Hospital,Beijing Friendship Hospital,Capital Medical University and Beijing Anzhen Hospital,Capital Medical University.Patients were randomized divided into two groups.The one underwent FFR guided complete revascularization to treatment non infarct related vessels(complete revascularization group,48 cases),and the other one underwent coronary angiography guided incomplete revascularization to treat infarct related vessels only in the acute phase(only infarct related vessels treated group,53 cases).PCI related indexes and occurrence of postoperative cardiocerebral vascular events during follow-up were compared bewteen the two groups.The primary endpoint was all-cause death,nonfatal myocardial infarction,revascularization,and cerebrovascular events at 12 months of follow-up.Results Compared with the only infarct related vessels treated group,the total operation time in the complete revascularization group was longer[(65±11)min vs(59±8)min],and the total length of the stent was shorter[(31±10)mm vs(36±10)mm](both P<0.05).In the complete revascularization group,26 cases(54.2%)were treated with PCI for non infarct related vessels under the guidance of FFR.The incidences of angina pectoris,revascularization and primary endpoint events in the complete revascularization group were lower than those in the only infarct related vessels treated group at 12 months of follow-up[4.2%(2/48)vs 18.9%(10/53),6.2%(3/48)vs 22.6%(12/53),8.3%(4/48)vs 24.5%(13/53)](all P<0.05).Conclusion For STEMI patients with multivessel disease undergoing primary PCI,FFR guided complete revascularization reduces the risk of cardiocerebral vascular events than PCI only treated infarct related vessels.