血流储备分数在指导冠状动脉分叉病变治疗策略中的作用

摘要

Objective To explore the effects of left anterior descending (LAD) coronary artery stent implantation on the first diagonal(D1) coronary artery,and illustrate the role of fractional flow reserve(FFR) in guiding percutaneous coronary inter-vention(PCI) strategy in patients with coronary artery bifurcation lesions. Methods Totally 63 patients with LAD coronary artery lesions were enrolled and divided into the group of FFR>0.80(n=48) and the group of FFR≤0.80(n=15) according to the FFR value of D1 after LAD stent implantation to observe and record patients′general clinical features and results of hematologic examina-tion before angiography including blood routine,blood glucose,low density lipoprotein,renal function,uric acid and so on. Re-sults The difference between the groups on LAD reference diameter [(3.30±0.17) vs. (3.34±0.27)mm,P=0.882],percentage of quantitative coronary angiography(QCA) diameter stenosis [(0.89±0.10)%vs. (0.88±0.12)%,P=0.934],LAD lesion length[(20.50± 6.40) vs.(22.70±8.90)mm,P=0.765],LAD FFR value before PCI[(0.65±0.11) vs.(0.63±0.15),P=0.837], D1 reference diameter [(2.62±0.17) vs.(2.63±0.19)mm,P=0.794],percentage of D1 diameter stenosis by QCA after PCI [(0.47±0.24)%vs.(0.58± 0.20)%,P=0.109] and D1 minimum luminal diameter after PCI [(1.39±0.62) vs.(1.12±0.55)mm,P=0.141] had no statistical sig-nificance(P>0.05). The D1 FFR value after LAD PCI had statistical difference between groups [(0.91±0.05) vs.(0.69±0.04)] with statistically significant difference(P<0.01). After LAD PCI,16.7% of the patients(8/48) in the group of FFR>0.80 were false positive with the QCA diameter stenosis no less than 70.0%;66.7%of the patients(10/15) in the group of FFR≤0.80 were false negative with the QCA diameter stenosis less than 70.0%. Conclusion FFR has great significance in guiding ercutaneous coronary intervention in patients with coronary artery bifurcation lesions ,and it can reduce complexity of PCI procedures obviously.%目的：评估左冠状动脉前降支支架植入后对第一对角支的影响，阐明血流储备分数（FFR）在指导冠状动脉分叉病变策略制订中的作用。方法纳入63例左冠状动脉前降支病变患者，冠状动脉左前降支（LAD）支架植入后，根据边支FFR值分为FFR＞0.80组（48例）及FFR≤0.80组（15例）。观察并记录患者一般临床特征及造影前血液学检查结果包括血常规、血糖、低密度脂蛋白、肾功能、尿酸等。结果两组患者经皮冠状动脉介入（PCI）术前LAD参考血管直径[（3.30±0.17）、（3.34±0.27）mm，P=0.882]、定量冠状动脉造影（QCA）直径狭窄百分比[（0.89±0.10）%、（0.88±0.12）%，P=0.934]、病变长度[（20.50±6.40）、（22.70±8.90）mm，P=0.765]、FFR均值（0.65±0.11、0.63±0.15，P=0.837），LAD PCI后对角支参考血管直径[（2.62±0.17）、（2.63±0.19）mm，P=0.794]、QCA病变直径狭窄百分比[（0.47±0.24）%、（0.58±0.20）%，P=0.109]、最小管腔直径[（1.39±0.62）、（1.12±0.55）mm，P=0.141]比较，差异均无统计学意义（P＞0.05）；而LAD PCI后对角支FFR均值（0.91±0.05、0.69±0.04）比较，差异有统计学意义（P＜0.01）。前降支支架植入后，在对角支FFR＞0.80组，有16.7%（8/48）患者QCA直径狭窄大于或等于70.0%为假阳性；在对角支FFR≤0.80组，有66.7%（10/15）患者QCA直径狭窄小于70.0%为假阴性。结论 FFR在指导冠状动脉分叉病变治疗策略中具有重要意义，可显著降低分叉病变处理的复杂性。