冠状动脉分叉临界病变边支行血流储备分数测定的临床意义

Clinical effect of treatment with the guidance of the fractional flow reserve in coronary artery bifurcation lesion

目的:分析血流储备分数(fractional flow reserve,FFR)指导的冠状动脉分叉临界病变边支介入治疗的临床效果。方法:回顾性分析冠状动脉主支支架植入后行边支治疗的冠状动脉分叉临界病变患者80例,分为FFR指导边支介入组(FFR组)和常规介入组,每组40例。其中FFR组对FFR测值<0.75的边支血管行介入治疗,包括双球囊对吻及必要时的支架植入。比较两组患者的临床资料、冠状动脉介入治疗结果以及术后随访的心血管不良事件(MACE)。结果:两组在边支支架的植入、双球囊对吻、术后边支残余狭窄>50%中差异有统计学意义(P分别为0.026,0.021,0.043)。两组随访6个月,18个月时MACE发生率差异无统计学意义(P>0.05);在3年MACE中FFR组的发生率比常规介入组低(P<0.05)。结论:FFR指导分叉病变边支治疗会更少地使用球囊与支架,3年的随访中FFR指导组MACE发生率比常规冠状动脉造影组要低。

Objective: To study the value of fractional flow reserve( FFR) for critical lesion of coronary bifurcation in percutaneous coronary intervention( PCI). Methods: A total of 80 inpatients with bifurcation critical lesion of coronary were investigated. The matched patients were divided into FFR guiding group( FFR group) and conventional PCI group,40 cases for each group. The data including basic clinical characteristics,results of PCI,and main adverse cardiovascular events( MACE) during follow-up were analyzed retrospectively. Results: There were significantly difference in side-branch lesion stent implanted after PCI,the ratio of kissing balloon,and the remanent stenosis( > 50 percent in diameter) of side-branch between the FFR group and the conventional PCI group( P was 0. 026,0. 021,and 0. 043,respectively). The total ratio of MACE between two groups had no statistic difference at six-month and 18 months follow-up( P >0. 05). However,the incidence of MACE after 3 years of follow-up was higher in conventional PCI group than that of FFR group( P < 0. 05). Conclusion: FFR for bifurcation critical lesion of coronary may reduce unnecessary application of kissing balloon or stenting in side-branch of bifurcation,and reduce the occurrence of MACE after PCI in following up.