冠状动脉造影联合血流储备分数测定对冠心病患者经皮冠状动脉介入治疗策略的影响

摘要

Objective To explore the effect of coronary angiography ( CAG) combined with fractional flow reserve ( FFR) in treatment strategies for percutaneous coronary intervention ( PCI) patients with coronary heart disease .Methods We enrolled 82 patients who were diagnosed as coronary artery stenosis 70%-90%by CAG and were planning to receive PCI in the Hospital of Xinjiang Production& Construction Corps from July 2012 to January 2013.Using random number table method , we divided the patients into two groups: observation group (n =40, 72 lesions) and control group (n =42, 75 lesions).In observation group , FFR determination was conducted on the blood vessels of every lesion , drug eluting stents ( DES ) were planted at the spots with FFR≤0.80, and FFR>0.80 was maintained after surgery .Conventional PCI after CAG was conducted in control group.We recorded number of stents , expense for coronary disease , incidence of major adverse cordial events ( myocardial infarction and revascularization ) and incidence of stenocardia relapse within the 18 months after surgery .Results The two groups were not significantly different (P>0.05) in gender, age, smoking history, history of diabetes mellitus, TC, TG, HDL-C and LDL-C.The observation group was lower ( P<0.05) than the control group in number of stents and expense for coronary disease.The two group were not significantly different ( P >0.05 ) in incidence of myocardial infarction , revascularization and incidence of stenocardia relapse within 18 months after PCI surgery .Conclusion CAG combined with FFR can reduce the number of stent and medical expense for patients with coronary disease , and it causes no increase in the incidence of major adverse cardiac events and stenocardia within 18 months after surgery .%目的：探讨冠状动脉造影（ CAG）联合血流储备分数（ FFR）测定对冠心病患者经皮冠状动脉介入（ PCI）策略的影响。方法选取2012年7月—2013年1月新疆生产建设兵团医院经CAG明确狭窄程度为70％～90％且拟行PCI的患者82例为研究对象，按完全随机数字表法将患者分为观察组（40例，72处病变）和对照组（42例，75处病变）。观察组患者每处病变血管均行FFR测定，仅在FFR≤0.80处行药物洗脱支架（ DES ）植入，并确保术后FFR＞0.80。对照组患者常规CAG检查后行PCI。记录两组患者植入支架数量， PCI术后18个月冠心病病种花费、主要心脏不良事件（心肌梗死、血运重建）及心绞痛发生情况。结果两组患者性别、年龄、吸烟史、糖尿病病史及总胆固醇（ TC）、三酰甘油（ TG）、高密度脂蛋白胆固醇（ HDL-C）、低密度脂蛋白胆固醇（ LDL-C）水平比较，差异均无统计学意义（P＞0.05）。观察组植入支架数量、冠心病病种花费均少于对照组，差异有统计学意义（P＜0.05）。两组PCI术后18个月内心肌梗死、血运重建和心绞痛发生率比较，差异无统计学意义（ P＞0.05）。结论 CAG联合FFR测定可减少冠心病患者植入支架数量、降低冠心病医疗费用， PCI术后18个月内未发现主要心脏不良事件及心绞痛发生率增加。