血流储备分数在冠状动脉分叉病变血管不同介入策略的效果评价

Evaluation of the effect of different interventional strategies for branch vessels of coronary bifurcation lesions under the guidance of fractional flow reserve in multivessel disease

目的:探讨在多支病变中血液储备分数(fractional flow reserve,FFR)指导下冠状动脉分叉病变分支血管不同介入策略的安全性及有效性。方法:入选2017年8月,至2018年8月北京市平谷区医院及首都医科大学附属北京安贞医院冠状动脉造影提示多支病变,冠状动脉置入支架后分支血管开口狭窄70%以上的患者。按随机数字表法分为两组,一组以FFR为指导,根据FFR结果决定分支病变处理方法。另一组以冠状动脉造影为指导,分支行常规处理。比较两组人口学特征、主要实验室检查、冠状动脉介入术(percutaneous coronary intervention,PCI)相关指标及数据、随访1年内主要不良心血管事件。结果:两组比较支架数量、支架总长、边支处理(如边支球囊扩张、支架置入例数)、球囊数量、球囊对吻例数、手术操作时长等指标,FFR组少于冠状动脉造影组,差异有统计学意义。两组比较平均支架直径、主支预扩张、残余狭窄≥30%、手术相关费用,两组间差异无统计学意义。两组心源性死亡、急性心肌梗死,支架内亚急性/晚期血栓、心绞痛、支架内再次血运重建、心功能分级,超声心动EF值等,均差异无统计学意义。结论:在多支病变中,与分支血管常规PCI治疗相比,以FFR为指导的冠状动脉分叉病变分支血管治疗策略,安全可行,缩短了整体手术时间、减少了分支介入手术操作、减少了人体异物置入,具有更高的工作效率,并且不增加术后1年内不良事件。

Objective:To explore the safety and efficacy of different interventional strategies guided by fractional flow reserve(FFR)in coronary bifurcation lesions in multiple branch lesions.Methods:Patients selected from August 2017 to August 2018,Beijing Pinggu District Hospital and Beijing Anzhen Hospital affiliated to Capital Medical University were selected with coronary angiography indicating multiple branch lesions and more than 70%of branch vessel opening stenosis after coronary stent implantation.It was divided into 2 groups according to the random number table method,and one group was guided by FFR and decided on the branching lesion treatment method according to the FFR results.The other group was routinely processed by coronary angiography.Demographic characteristics,primary laboratory tests,indicators and data related to PCI,and major adverse cardiovascular events within the 1-year follow-up were compared between the two groups.Results:The two groups compared the number of stents,the total length of stents,side branch treatment(such as balloon dilation,stent implantation),the number of balloons,the number of balloon kissing,surgical duration and other indicators.The FFR group was less than the coronary angiography group,which showed statistical differences.Two groups compared mean stent diameter,major branch predilation,residual stenosis of 30%,and procedure-related costs,with no statistical difference between the two groups.The two groups compared cardiac death,acute myocardial infarction,subacute/late thrombosis,angina,in-stent resurgent revascularization,cardiac function grade,and no statistical difference in echocardiographic EF values.Conclusions:In multiple lesions,compared with conventional PCI treatment,FFR guided coronary bifurcation lesion branch vascular treatment strategy,safe and feasible,shorten the overall operation time,reduce the branch interventional surgery,reduce human foreign body implantation,has higher work efficiency,and does not increase the adverse events within 1 year after surgery.