對FFR指導冠脈臨界病變延遲PCI的分析
發(fā)布時間：2019-04-22 08:26
【摘要】：目的本研究通過對冠脈造影提示臨界病變者,以心肌血流儲備分數(shù)為指導來決定是否行介入治療,分別隨訪術(shù)后1個月、6個月、12個月嚴重心絞痛發(fā)作情況、運動試驗陽性和主要不良心血管事件的發(fā)生情況,借此來評價心肌血流儲備分數(shù)在指導冠脈臨界病變延遲PCI的價值。方法連續(xù)選取于2014年1月至2014年11月,診斷不穩(wěn)定性心絞痛,在某醫(yī)院心內(nèi)科住院治療,接受冠脈造影(CAG)檢查結(jié)果示冠脈血管局限性的臨界病變者,病變參考血管直徑(RD)大于2.5mm,且病變的直徑狹窄率(DS)介于50%至70%之間的患者94例。分成三組,CAG藥物治療組、FFR延遲治療組、FFR介入治療組。其中CAG藥物治療組34例,給予最優(yōu)化藥物治療;FFR延遲治療組30例是對FFR075的病變不進行PCI治療僅給予規(guī)范的冠心病二級預防藥物治療;FFR介入治療組30例是對FFR≤0.75的病變行PCI治療,行PCI治療者均植入藥物涂層支架。所有患者均給予最優(yōu)化的冠心病二級預防治療。術(shù)后分別隨訪1個月、6個月、12個月,觀察隨訪期間三組TG、LDL-C、HDL、LDH、CK、CKMB、c TN-I、NT-pro BNP、LVEF數(shù)值、運動實驗的變化分別在術(shù)后1個月、6個月、12個月有無統(tǒng)計學差異;并隨訪三組在MACE(主要不良心臟事件)包括死亡、非致死性心肌梗死、靶血管血運重建和嚴重心絞痛發(fā)作情況(這里指CCS心絞痛分級Ⅲ級以上)有無差異來評價FFR指導下延遲治療組的效果。結(jié)果所有患者均完成隨訪,無一人失訪。結(jié)果顯示三組患者在年齡、性別、吸煙史、高血壓、高脂血癥、糖尿病、化驗指標(TG、HDL、LDH、CK、CK-MB、c TN-I、NT-pro BNP)、左室射血分數(shù)(LVEF值)、血管病變分布等臨床特征方面沒有統(tǒng)計學差異(P0.05)。FFR介入治療組植入支架34枚(1.10±0.30),行支架植入者支架均植入成功,術(shù)后血流達TIMI3級。三組患者均給予最優(yōu)化藥物治療開展冠心病二級預防。三組患者化驗資料、LVEF在隨訪中比較無顯著統(tǒng)計學差異(P0.05)。術(shù)后隨訪顯示第1個月和第6個月均未發(fā)生MACE,運動實驗和嚴重心絞痛發(fā)作情況無顯著統(tǒng)計學差異(P0.05)。隨訪12個月結(jié)果示三組病例在MACE上無明顯統(tǒng)計學意義(P0.05)。三組病例在運動試驗陽性方面差異有統(tǒng)計學意義(P0.05),CAG藥物治療組運動試驗陽性率最高,FFR延遲治療組居中,FFR介入治療組最低;兩兩比較顯示:FFR介入治療組與CAG藥物治療組間以及FFR延遲治療組CAG藥物治療組間差異均有統(tǒng)計學意義(P0.05);FFR介入治療組與FFR延遲治療組間差異不顯著(P0.05)。三組病例在嚴重心絞痛發(fā)作方面差異有統(tǒng)計學意義(P0.05),CAG藥物治療組嚴重心絞痛發(fā)生率最高;兩兩比較顯示:FFR介入治療組與CAG藥物治療組間差異最顯著(P0.05);FFR延遲治療組與FFR介入治療組間及FFR延遲治療組與CAG藥物治療組差異不顯著。臨界病變運動試驗陽性者更傾向于PCI。結(jié)論1 FFR指導下延遲PCI藥物治療沒有增加MACE的風險,FFR在指導冠狀動脈臨界病變延遲PCI安全可靠;2 FFR指導臨界病變介入治療可以降低嚴重心絞痛發(fā)作、運動平板陽性的發(fā)生,改善心肌缺血,提高運動耐力;FFR指導下延遲PCI治療同樣可以改善心肌缺血,提高運動耐力。
[Abstract]:Objective To study the effect of coronary angiography on the critical lesion of angina pectoris, and to determine whether to perform interventional therapy on the basis of myocardial blood flow reserve score, and follow-up of 1-month,6-month and 12-month severe angina pectoris after follow-up. The occurrence of positive and major adverse cardiovascular events in the exercise test is used to evaluate the value of myocardial blood flow reserve in the guidance of the delayed PCI of the critical coronary artery disease. Methods From January 2014 to November 2014, the patients with unstable angina pectoris were diagnosed with unstable angina pectoris. The results of coronary angiography (CAG) and coronary angiography (CAG) were used to show the critical lesions of the limitation of the coronary artery. The reference vessel diameter (RD) of the lesion was greater than 2.5 mm. And the stenosis rate (DS) of the lesion was between 50 and 70% of the patients. Three groups were divided into three groups: the CAG drug treatment group, the FFR delayed treatment group, and the FFR intervention treatment group. in which 34 of the CAG drug treatment groups were treated with an optimized drug; the FFR delayed treatment group 30 was a coronary heart disease secondary prevention drug treated only by the PCI treatment for the lesion of the FFR075; the FFR intervention treatment group 30 was a lesion line PCI treatment of the FFR group 0.75, All PCI-treated patients were implanted with a drug-coated stent. All patients were given the optimized secondary prevention of coronary heart disease. Three groups of TG, LDL-C, HDL, LDH, CK, CKMB, c-TN-I, NT-pro BNP and LVEF were followed up for 1 month,6 months and 12 months, respectively. The effectiveness of the delayed treatment group under FFR guidance was evaluated with the presence or absence of differences in the MACE (major adverse cardiac events), including death, non-fatal myocardial infarction, target vessel revascularization, and severe angina (here, CCS angina grade III or above). Results All patients were followed up and no one was lost to follow-up. The results showed that the three groups were in age, sex, smoking history, hypertension, hyperlipidemia, diabetes, test index (TG, HDL, LDH, CK, CK-MB, c TN-I, NT-pro BNP) and left ventricular ejection fraction (LVEF). There was no statistical difference in the clinical features such as the distribution of vascular lesions (P0.05). The FFR was implanted in 34 (1.10, 0.30), and the stent-implanted stents were successfully implanted and the blood flow reached the TITI3 stage. The second prevention of coronary heart disease was carried out in three groups of patients. There was no significant difference between the three groups (P0.05). There was no significant difference in the incidence of MACE, exercise and severe angina in the first and sixth months after the operation (P0.05). The results of 12-month follow-up showed no significant difference in MACE (P0.05). There was a significant difference in the positive aspects of the three groups (P0.05). The positive rate of the exercise test in the CAG group was the highest, the FFR delayed treatment group was the lowest, and the FFR was the lowest in the treatment group, and the two comparisons showed that: There was no significant difference between the treatment groups of the FFR intervention group and the CAG drug treatment group and the group of the FFR delayed treatment group (P0.05); the difference between the FFR intervention treatment group and the FFR delayed treatment group was not significant (P0.05). There was a significant difference in the incidence of severe angina (P0.05). The incidence of severe angina in the treatment group was the highest in the treatment group of CAG. The two comparisons showed that the difference between the two groups was the most significant (P0.05). The difference between the FFR-delayed treatment group and the FFR-delayed treatment group and the FFR-delayed treatment group was not significant. The patients with critical lesion movement were more prone to PCI. Conclusion 1 FFR-guided PCI drug therapy did not increase the risk of MACE. FFR was safe and reliable to guide the delayed PCI of the coronary critical lesion. FFR-guided interventional therapy could reduce the onset of severe angina, the occurrence of positive plate positive, and improve the myocardial ischemia. Improve that endurance of exercise; the delayed PCI treatment under the guidance of FFR can also improve the myocardial ischemia and improve the exercise endurance.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R54
本文編號：2462677
[Abstract]:Objective To study the effect of coronary angiography on the critical lesion of angina pectoris, and to determine whether to perform interventional therapy on the basis of myocardial blood flow reserve score, and follow-up of 1-month,6-month and 12-month severe angina pectoris after follow-up. The occurrence of positive and major adverse cardiovascular events in the exercise test is used to evaluate the value of myocardial blood flow reserve in the guidance of the delayed PCI of the critical coronary artery disease. Methods From January 2014 to November 2014, the patients with unstable angina pectoris were diagnosed with unstable angina pectoris. The results of coronary angiography (CAG) and coronary angiography (CAG) were used to show the critical lesions of the limitation of the coronary artery. The reference vessel diameter (RD) of the lesion was greater than 2.5 mm. And the stenosis rate (DS) of the lesion was between 50 and 70% of the patients. Three groups were divided into three groups: the CAG drug treatment group, the FFR delayed treatment group, and the FFR intervention treatment group. in which 34 of the CAG drug treatment groups were treated with an optimized drug; the FFR delayed treatment group 30 was a coronary heart disease secondary prevention drug treated only by the PCI treatment for the lesion of the FFR075; the FFR intervention treatment group 30 was a lesion line PCI treatment of the FFR group 0.75, All PCI-treated patients were implanted with a drug-coated stent. All patients were given the optimized secondary prevention of coronary heart disease. Three groups of TG, LDL-C, HDL, LDH, CK, CKMB, c-TN-I, NT-pro BNP and LVEF were followed up for 1 month,6 months and 12 months, respectively. The effectiveness of the delayed treatment group under FFR guidance was evaluated with the presence or absence of differences in the MACE (major adverse cardiac events), including death, non-fatal myocardial infarction, target vessel revascularization, and severe angina (here, CCS angina grade III or above). Results All patients were followed up and no one was lost to follow-up. The results showed that the three groups were in age, sex, smoking history, hypertension, hyperlipidemia, diabetes, test index (TG, HDL, LDH, CK, CK-MB, c TN-I, NT-pro BNP) and left ventricular ejection fraction (LVEF). There was no statistical difference in the clinical features such as the distribution of vascular lesions (P0.05). The FFR was implanted in 34 (1.10, 0.30), and the stent-implanted stents were successfully implanted and the blood flow reached the TITI3 stage. The second prevention of coronary heart disease was carried out in three groups of patients. There was no significant difference between the three groups (P0.05). There was no significant difference in the incidence of MACE, exercise and severe angina in the first and sixth months after the operation (P0.05). The results of 12-month follow-up showed no significant difference in MACE (P0.05). There was a significant difference in the positive aspects of the three groups (P0.05). The positive rate of the exercise test in the CAG group was the highest, the FFR delayed treatment group was the lowest, and the FFR was the lowest in the treatment group, and the two comparisons showed that: There was no significant difference between the treatment groups of the FFR intervention group and the CAG drug treatment group and the group of the FFR delayed treatment group (P0.05); the difference between the FFR intervention treatment group and the FFR delayed treatment group was not significant (P0.05). There was a significant difference in the incidence of severe angina (P0.05). The incidence of severe angina in the treatment group was the highest in the treatment group of CAG. The two comparisons showed that the difference between the two groups was the most significant (P0.05). The difference between the FFR-delayed treatment group and the FFR-delayed treatment group and the FFR-delayed treatment group was not significant. The patients with critical lesion movement were more prone to PCI. Conclusion 1 FFR-guided PCI drug therapy did not increase the risk of MACE. FFR was safe and reliable to guide the delayed PCI of the coronary critical lesion. FFR-guided interventional therapy could reduce the onset of severe angina, the occurrence of positive plate positive, and improve the myocardial ischemia. Improve that endurance of exercise; the delayed PCI treatment under the guidance of FFR can also improve the myocardial ischemia and improve the exercise endurance.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R54
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