北京大学学报(医学版) ›› 2014, Vol. 46 ›› Issue (6): 844-847.

• 论著 • 上一篇    下一篇

临界病变造影指导与血流储备分数指导的冠状动脉介入治疗策略比较

龚艳君,胡灏,蒋捷△,洪涛,李建平,陈明,刘兆平,霍勇   

  1. (北京大学第一医院心内科,北京100034)
  • 出版日期:2014-12-18 发布日期:2014-12-18

Comparison of angiography-guided and fractional flow reserve-guided management strategy of percutaneous coronary intervention for intermediate coronary lesions

GONG Yan-jun, HU Hao, JIANG Jie△, HONG Tao, LI Jian-ping, CHEN Ming, LIU Zhao-ping, HUO Yong   

  1. (Department of Cardiology, Peking University First Hospital, Beijing 100034, China)
  • Online:2014-12-18 Published:2014-12-18

摘要: 目的:比较对临界病变分别应用造影指导和血流储备分数(fractional flow reserve,FFR)指导的治疗策略的一致性。方法:入选2012年11月至2014年8月因“冠心病”于北京大学第一医院行冠状动脉造影检查,且术者判断为临界病变并行FFR检查的患者。收集所有患者的造影图像,由4位有经验的心脏介入医生分别对造影图像中靶病变的狭窄程度进行目测判读,并写出该医生本人根据影像结果从治疗策略上是否会对该处靶病变进行经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)。收集患者手术当时术者判断的狭窄程度及FFR值,分析手术当时术者判断的狭窄程度与事后4位介入医生判断的狭窄程度的差异及相关性,并分析4位介入医生根据造影指导选择的治疗策略与FFR指导的治疗策略的一致性。结果:共入选151例患者,70.2%(106例)为男性,平均年龄(62.7±9.6)岁(37~84岁)。对该151例患者的169支血管的临界病变进行了FFR测量,1支为左主干,116支为前降支,27支为回旋支,25支为右冠状动脉。虽然事后4位介入医生目测判断的狭窄程度与术中目测判断的狭窄程度有一定相关性(r=0.29~0.38,P<0.001),但相关性不高,且有明显差异。以FFR值0.80为选择是否行介入治疗的界值,4位介入医生根据影像目测结果选择的治疗策略与FFR指导的治疗策略之间的一致性分别为:医生1为72.78%,医生2为71.60%,医生3为75.15%,医生4为72.78%。结论:单纯根据造影目测判断临界病变准确性不高,推荐在临床上使用FFR测量来指导临界病变治疗策略的选择。

关键词: 血流储备分数, 心肌, 血管造影术, 经皮冠状动脉介入治疗, 冠状动脉疾病

Abstract: Objective:To compare the consistency of angiography-guided and fractional flow reserve (FFR)-guided management strategy for intermediate coronary lesions. Methods: The patients whose coronary intermediate lesions were assessed by measuring FFR from November 2012 to August 2014. The stenosis percentage and value of FFR during the procedure were collected. All the image data were collected and four experienced interventional cardiologists were invited to assess the target lesions and make a management strategy independently. The consistency of angiographyguided and fractional flow reserve-guided management strategy were analyzed. Results: In the study, 151 patients were included, of whom, 70.2% were male, the average age was (62.7±9.6) years, 169 vessels were assessed by measuring FFR, 1 being left main, 116 left anterior descending, 27 left circumflex branch, and 25 right coronary artery. There were some correlationship between the stenosis percentage judged by four interventional cardiologists and the stenosis percentage judged during the procedure (r=0.29-0.38, P<0.001), but the difference was significant. When 0.80 was used as FFR threshold value, the consistency rates of angiography-guided management strategy decision made by the four cardiologists with fractional flow reserve-guided management strategy were 72.78%, 71.60%, 75.15%, and 72.78%, respectively. Conclusion: Angiography-guided management strategy decision is unreliable, FFR is recommended for management strategy decision for intermediate coronary lesions.

Key words: Fractional flow reserve, myocardial, Angiography, Percutaneous coronary intervention, Coronary artery disease

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