血流储备分数指导下ST段抬高型心肌梗死多支血管病变患者非梗死相关血管分期完全血运重建的临床研究

摘要

Objective To evaluate the clinical value of fractional flow reserve(FFR) for non-infarct related artery(non-IRA) staged complete revascularization in patients with ST-segment elevation myocardial infarction(STEMI) and multiple vessel disease.Methods Selected STEMI patients with multiple vessel disease accepting emergency PCI and planed to be staged PCI in the treatment of non-IRA in our hospital.Ninety Patients were randomly divided into FFR guiding group (n =45) and coronary angiography (CAG) guiding group(n =45).In FFR group,FFR were performed in the diseased vessels with 70％-90％ stenosis and FFR ＜ 0.80 as the indication for PCI treatment;Stenosis of more than 70％ lesions as the indication for PCI treatment in CAG Group.PCI time,the number of stent implantation,the dosage of contrast agent,length of stay,hospital costs and surgical complications were compared between the two groups.Patients were followed up for 6 months and major adverse cardiovascular events were compared between the two groups.Results In FFR group the number of stent placement and contrast medium dose was significantly less than those in CAG group (1.68 ± 0.75 vs.2.83 ± 0.54,t =7.662,P ＜ 0.001).After 6 months of follow-up,FFR group revascularization was significantly lower than that in CAG group(4.7％ vs.19.5％,P =0.04).There was no significant difference in major adverse cardiovascular events between the two groups (P ＞ 0.05).Conclusions In patients with STEMI and multiple vessel disease,non-IRA staged complete revascularization under the guidance of FFR can reduce the number of stent implantation and the dosage of contrast agent,and the rate of revascularization after 6 months.%目的 评估血流储备分数(FFR)在急性ST段抬高型心肌梗死(STEMI)多支血管病变患者非梗死相关血管(non-IRA)分期经皮冠状动脉介入治疗(PCI)完全血运重建中的临床价值. 方法 选取陕西中医药大学第二附属医院心血管内科2015年6月至2016年5月已成功行PCI开通梗死相关血管(IRA),拟分期PCI治疗(间隔≥7d)non-IRA的STEMI多支血管病变患者90例,按随机数字表法分为FFR指导下完全血运重建组(FFR组)45例和冠状动脉造影指导下完全血运重建组(CAG组)45例.FFR组狭窄＞90％的non-IRA病变直接行PCI治疗,对狭窄70％～90％的病变行FFR检查,仅对FFR＜0.80的non-IRA行PCI治疗;CAG组对狭窄≥70％的non-IRA依据术者经验行PCI治疗,处理的靶血管参照血管直径≥2.5 mm.比较两组PCI时间、支架置入数量、造影剂用量、住院时间、住院费用和围术期并发症,随访患者术后6个月主要不良心脑血管事件发生情况. 结果 FFR组支架置入数量[(1.68±0.75)枚比(2.83±0.54)枚,t=7.662,P＜0.001]和造影剂用量[(164.8 ±35.7)ml比(195.0 ±41.9)ml,=4.271,P=0.04]均明显少于CAG组;术后随访6个月,FFR组再次血运重建率显著低于CAG组(4.7％比19.5％,P=0.04),两组主要不良心脑血管事件发生率差异无统计学意义(均为P ＞0.05). 结论 STEMI多支血管病变患者在FFR指导下对non-IRA行分期完全血运重建可减少支架置入数量、造影剂用量及术后6个月再次血运重建率.