远隔缺血预适应对药物球囊扩张术后冠状动脉功能学的影响

The impact of distal ischemic preconditioning on coronary function in patients with non-ST segment elevation-acute coronary syndrome undergoing drug-coated balloon dilation angioplasty

目的:本研究旨在探索接受药物球囊(drug-coated balloon,DCB)扩张术的非ST段抬高型急性冠状动脉综合征(non-ST-segment elevation-acute coronary syndrome,NSTEACS)人群中,远隔缺血预适应(distal ischemic preconditioning,RIPC)对冠状动脉功能学的影响。方法:研究纳入2019年10月至2020年10月,就诊于郑州大学第一附属医院明确诊断为NSET-ACS并使用DCB治疗冠状动脉原位病变的患者120例。根据术前是否进行RIPC处理分为两组:对照组(n=60)和RIPC组(n=60)。主要结局:术前术后冠状动脉血流储备分数(fraction coronary flow reserve,FFR)的变化值。次要结局:术前FFR值和术后FFR值。通过多元线性回归分析关键变量与FFR变化值的关系。结果:两组的FFR变化值[(0.26±0.03)vs.(0.19±0.03),P<0.001]和术后[(0.91±0.04)vs.(0.85±0.03),P<0.001]。两组术前FFR值差异无统计学意义。在多元线性回归分析中,ACEI(β=0.11,95%CI:0.01~0.22,P=0.048)、RIPC(β=0.82,95%CI:0.71~0.93,P<0.001)与FFR变化值呈正相关。吸烟(β=-0.13,95%CI:-0.23~-0.01,P=0.027)、高血压(β=-0.14,95%CI:-0.25~-0.02,P=0.019)、回旋支病变(β=-0.12,95%CI:-0.23~-0.01,P=0.031)与FFR变化值呈负相关。结论:在接受DCB扩张术的CNSTE-ACS患者人群中,RIPC组术前术后FFR变化值及术后FFR值明显高于对照组。

Objective:Fractional coronary flow reserve(FFR)is the most widely used tool to evaluate coronary flow function.Distal ischemic preconditioning(RIPC)can reduce reperfusion injury during coronary flow recovery.The purpose of this study was to explore the effect of RIPC on FFR in patients with non-ST-segment elevation-acute coronary syndrome(NSTE-ACS)undergoing drug-coated balloon(DCB)dilatation angioplasty.Methods:The study included patients with NSTE-ACS undergoing DCB dilatation angioplasty who were hospitalized in The First Affiliated Hospital of Zhengzhou University from October 2019 to October 2020.Enrolled patients were divided into two groups according to whether they accepted the RIPC before intervention:control group(n=60)and RIPC group(n=60).The primary outcome was change of the FFR values before and after intervention.The secondary outcomes were the FFR values before and after intervention respectively.Comparisons of outcomes between two groups were conducted using independent T test.Multivariate linear regression analysis was used to determine the relationship between key variables and change of the FFR in NSTE-ACS patients.Results:The change of FFR values[RIPC group vs.control group:(0.26±0.03)vs.(0.19±0.03),P<0.001]and post-intervention FFR values[RIPC group vs.control group:(0.91±0.04)vs.(0.85±0.03),P<0.00]were significantly higher in the RIPC group respectively.While,there was no significant difference in pre-intervention FFR values between the two groups[RIPC group vs.control group:(0.65±0.04)vs.(0.65±0.05),P=0.547].In multiple linear regression analysis,ACEI(β=0.11,95%CI:0.01-0.22,P=0.048)and RIPC(β=0.82,95%CI:0.71-0.93,P<0.001)were positively correlated with the change of FFR values.Smoking(β=-0.13,95%CI:-0.23--0.01,P=0.027),hypertension(β=-0.14,95%CI:-0.25--0.02,P=0.019),left circumflex(LCX)artery(β=-0.12,95%CI:-0.23--0.01,P=0.031)were negatively correlated with the change of FFR values.Conclusions:In NSTE-ACS patients undergoing DCB dilatation angioplasty,the change of FFR values and post-intervention FFR values were significantly higher in the RIPC group.