Prognostic impact of staged PCI intervention on non-infarct related artery guided by FFR in patients with ST segment elevation myocardial infarction
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摘要: 目的：探讨血流储备分数（FFR）指导下分期行经皮冠状动脉（冠脉）介入术（PCI）干预非梗死相关动脉（non-IRA）对ST段抬高型心肌梗死（STEMI）患者预后的影响。方法：将100例拟分期PCI干预non-IRA的STEMI患者随机分为FFR指导下功能性血运重建组（FFR组）和单纯冠脉造影指导下血运重建组（CAG组），各50例。FFR组对狭窄70%~90%的non-IRA行FFR检查，FFR ≤ 0.80为PCI干预的指证；CAG组对狭窄≥ 70%的non-IRA仅冠脉造影指导下行PCI。比较2组PCI资料和住院期间主要并发症，均术后随访12个月，比较2组术后1个月和12个月时主要不良心血管事件（MACE）的发生率。结果：FFR组和CAG组比较，人均支架植入量[（1.5±0.5）枚：（2.6±1.0）枚，P ≤ 0.01]和支架植入率[84.2%：100%，P=0.003]显著降低；2组的PCI时间、造影剂剂量、住院时间、住院费用和住院期间主要并发症均无统计学差异；术后1个月FFR组未增加MACE事件发生率[1例（2%）：3例（6%），P=0.617]；术后12个月FFR组MACE事件[2例（4.08%）：8例（16.70%），P=0.042]显著降低。结论：对STEMI多支血管病变患者在FFR指导下non-IRA分期功能性血运重建可减少不必要的PCI干预，降低术后12个月的MACE事件发生率。
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关键词:
- 血流储备分数 /
- 非梗死相关动脉 /
- ST段抬高型急性心肌梗死 /
- 多支血管病变 /
- 功能性血运重建
Abstract: Objective: To investigate the prognostic impact of staged PCI intervention on non-infarct related artery guided by FFR in patients with ST segment elevation myocardial infarction.Method: One hundred cases of STEMI patients were randomly divided into functional revascularization group guided by FFR (FFR group) and coronary angiography guided revascularization group (CAG group). Patients assigned to FFR group underwent stenting of indicated lesions only if FFR ≤ 0.80, whereas those assigned to CAG group underwent stenting of all indicated lesions with stenosis ≥ 70%. The coronary angiography results and the data of PCI were recorded. The number of stent used per patient, procedure time, hospitalization time, the amount of contrast agent used per patient and major complications during hospitalization were compared between the two groups. Patients were followed up for 12 months, the incidence of major adverse cardiovascular events (MACE) was compared between the two groups in one month and six months after PCI surgery.Result: Compared with CAG group, FFR group had decreased mean number of stents[(1.5±0.5) vs (2.6±1.0), P<0.01] and stent implantation rate[84.2% vs 100%, P=0.003]. There were no obvious difference in procedure time, the amount of contrast agent used per patient, the hospitalization time, hospitalization expenses and major complications during hospitalization between the two groups. In addition, there was no obvious difference in the incidence of MACE between the two groups in one month, but the incidence of MACE was obviously decreased in FFR group in six months after PCI surgery. Conclusion: Staged PCI functional revascularization can reduce unnecessary PCI intervention and the incidence of MACE events in 12 months after surgery in patients with ST segment elevation myocardial infarction and multivessel disease. -
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