CAJ | 학술논문

目的：通过测量血流储备分数（FFR），决定是否对不稳定型心绞痛多支血管病变患者经皮冠状动脉介入治疗（PCI）术中非罪犯中度狭窄血管行介入治疗，并观察临床转归。方法本研究入选不稳定型心绞痛多支血管病变患者，首先对已明确的罪犯血管行PCI治疗后，针对非罪犯中度狭窄血管按照单双号分为对照组（非支架组）和观察组（FFR指导下行PCI组）。其中，观察组FFR＜0.8的患者对中度狭窄血管行PCI治疗，术后再次行FFR检测，确保FFR≥0.95。观察终点事件为全因死亡、非致死性心肌梗死、再次血运重建发生率以及心绞痛临床表现。结果共纳入71例患者，对照组35例；观察组36例，其中FFR≥0.8的患者23例，FFR＜0.8的患者13例。两组患者无主要终点事件和再次血运重建生存率分别比较，差异均有统计学意义（P＜0.05）；无全因死亡与非致死性心肌梗死生存率分别比较，差异均无统计学意义。针对靶血管不良事件的统计学分析显示，两组再次血运重建（观察组5.6%，对照组31.4%）及非致死性心肌梗死（观察组5.6%，对照组28.6%）发生率分别比较，差异均有统计学意义（P＜0.05）。结论不稳定型心绞痛患者中，使用压力导丝测出的FFR值来决定是否对非罪犯中度病变进行血运重建是安全的。FFR结合冠状动脉造影指导PCI治疗较单纯冠状动脉造影指导PCI的不良事件发生率显著减少，尤其在再次血运重建方面，并且心绞痛临床表现显著缓解。
목적：통과측량혈류저비분수（FFR），결정시부대불은정형심교통다지혈관병변환자경피관상동맥개입치료（PCI）술중비죄범중도협착혈관행개입치료，병관찰림상전귀。방법본연구입선불은정형심교통다지혈관병변환자，수선대이명학적죄범혈관행PCI치료후，침대비죄범중도협착혈관안조단쌍호분위대조조（비지가조）화관찰조（FFR지도하행PCI조）。기중，관찰조FFR＜0.8적환자대중도협착혈관행PCI치료，술후재차행FFR검측，학보FFR≥0.95。관찰종점사건위전인사망、비치사성심기경사、재차혈운중건발생솔이급심교통림상표현。결과공납입71례환자，대조조35례；관찰조36례，기중FFR≥0.8적환자23례，FFR＜0.8적환자13례。량조환자무주요종점사건화재차혈운중건생존솔분별비교，차이균유통계학의의（P＜0.05）；무전인사망여비치사성심기경사생존솔분별비교，차이균무통계학의의。침대파혈관불량사건적통계학분석현시，량조재차혈운중건（관찰조5.6%，대조조31.4%）급비치사성심기경사（관찰조5.6%，대조조28.6%）발생솔분별비교，차이균유통계학의의（P＜0.05）。결론불은정형심교통환자중，사용압력도사측출적FFR치래결정시부대비죄범중도병변진행혈운중건시안전적。FFR결합관상동맥조영지도PCI치료교단순관상동맥조영지도PCI적불량사건발생솔현저감소，우기재재차혈운중건방면，병차심교통림상표현현저완해。
Objective To study the feasibility of using fractional flow reserve (FFR) to guide whether to perform coronary revascularization of non-culprit moderate stenosis in patients with unstable angina and estimate their clinical prognosis. Methods This study enrolled unstable angina patients with multivessel disease. First successful stenting of the culprit artery, then the other non-culprit moderate coronary stenosis were randomized into PCI guided by angiography or guided by FFR measurements. Death from any cause, nonfatal myocardial infarction, unplanned hospitalization leading to urgent revascularization and clinical manifestations with angina were followed during the first year. Results 71 patients were included, among them 35 patiens were randomly assigned to angiography-guided PCI and 36 patients to FFR-guided PCI. In FFR-guided PCI group, FFR was successfully measured in all of non-culprit moderate coronary stenosis. In 23 stenosis, the FFR was greater than 0.80, and stents were not placed in these stenosis. In 13 stenosis with FFR<0.8, stent were inplant and FFR was raised≥0.95 after stenting. The percentage of patients who had a primary end-point event was higher in the angiography-guided PCI group than the FFR-guided PCI group (P<0.05). Neither the rate of mortelity from any cause nor the rate of non-fatal myocardial infarction had significant difference between the 2 groups. Related to the target vessels rates of nonfatal myocardial infarction (5.6%vs. 28.6%) and target lesion revascularization (5.6%vs. 31.4%) were statistically different (P<0.01 and P<0.05, respectively). Conclusions In patients with unstable angina, it is safe to use FFR values to guide decisions on the revascularization of angiographically moderate non-culprit stenosis. Routine measurement of FFR in addition to angiographic guidance, as compared with PCI guided by angiography alone, results in a significant reduction in major adverse events at 1 year, particularly in urgent revascularization, and clinical manifestations with angina get better.