泰山医学院学报
泰山醫學院學報
태산의학원학보
JOURNAL OF TAISHAN MEDICAL COLLEGE
2014年
10期
976-979
,共4页
张树江%齐杰%刘汉清%王已亮
張樹江%齊傑%劉漢清%王已亮
장수강%제걸%류한청%왕이량
血流储备分数%稳定型%冠心病%效价
血流儲備分數%穩定型%冠心病%效價
혈류저비분수%은정형%관심병%효개
fractional flow reserve%stable%coronary artery disease%cost - effectiveness
研究背景血流储备分数(FFR)研究发现,同药物治疗组比较,至少一支冠脉 FFR ≤0.80的稳定型冠心病患者接受 PCI 治疗后,再次进行血流重建的概率减少,然而异常 FFR 指导的 PCI 术费用以及对于生活质量的影响并不明确。方法采用 EQ -5D 健康量表评估患者基线和治疗30天后效价,同时假设以月为单位效益改善来推断一年线性下降曲线,进而预测生活质量调整后的生存时间。结果根据一年的累计费用计算增加的效价比率。初期异常 FFR 指导的 PCI 治疗组费用明显高于药物治疗组(59670元 vs 23970元,P <0.01),然而在治疗初期两组间费用差值在随访结束后显著降低(36880元 vs.¥15230元,P <0.01),主要是由于药物治疗组再次血运重建费用增加。治疗一个月后,PCI 组患者效益较药物治疗组显著改善(0.055 vs 0.003,P <0.001)。结论 FFR 异常的临界病变的稳定型冠心病患者进行 PCI 治疗能改善临床效果,同时后继治疗较单纯药物治疗组更加经济。
研究揹景血流儲備分數(FFR)研究髮現,同藥物治療組比較,至少一支冠脈 FFR ≤0.80的穩定型冠心病患者接受 PCI 治療後,再次進行血流重建的概率減少,然而異常 FFR 指導的 PCI 術費用以及對于生活質量的影響併不明確。方法採用 EQ -5D 健康量錶評估患者基線和治療30天後效價,同時假設以月為單位效益改善來推斷一年線性下降麯線,進而預測生活質量調整後的生存時間。結果根據一年的纍計費用計算增加的效價比率。初期異常 FFR 指導的 PCI 治療組費用明顯高于藥物治療組(59670元 vs 23970元,P <0.01),然而在治療初期兩組間費用差值在隨訪結束後顯著降低(36880元 vs.¥15230元,P <0.01),主要是由于藥物治療組再次血運重建費用增加。治療一箇月後,PCI 組患者效益較藥物治療組顯著改善(0.055 vs 0.003,P <0.001)。結論 FFR 異常的臨界病變的穩定型冠心病患者進行 PCI 治療能改善臨床效果,同時後繼治療較單純藥物治療組更加經濟。
연구배경혈류저비분수(FFR)연구발현,동약물치료조비교,지소일지관맥 FFR ≤0.80적은정형관심병환자접수 PCI 치료후,재차진행혈류중건적개솔감소,연이이상 FFR 지도적 PCI 술비용이급대우생활질량적영향병불명학。방법채용 EQ -5D 건강량표평고환자기선화치료30천후효개,동시가설이월위단위효익개선래추단일년선성하강곡선,진이예측생활질량조정후적생존시간。결과근거일년적루계비용계산증가적효개비솔。초기이상 FFR 지도적 PCI 치료조비용명현고우약물치료조(59670원 vs 23970원,P <0.01),연이재치료초기량조간비용차치재수방결속후현저강저(36880원 vs.¥15230원,P <0.01),주요시유우약물치료조재차혈운중건비용증가。치료일개월후,PCI 조환자효익교약물치료조현저개선(0.055 vs 0.003,P <0.001)。결론 FFR 이상적림계병변적은정형관심병환자진행 PCI 치료능개선림상효과,동시후계치료교단순약물치료조경가경제。
Objective:Background The fractional flow reserve(FFR)trials demonstrated a significant reduction in sub-sequent coronary revascularization among patients with stable coronary artery disease and at least 1 coronary lesion with a FFR ≤0. 80 who were randomized to percutaneous coronary intervention(PCI)compared with best medical therapy. The economic and quality - of - life implications of PCI in the setting of an abnormal fractional flow reserve are unknown. Methods:We assessed patient utility using the EQ - 5D health survey at baseline and 1 month and projected quality - adjusted life - years assuming a linear decline over 1 years in the 1 - monthutility improvements. Results:We cal-culated the incremental cost - effectiveness ratio based on cumulative costs over 12 months. Initial costs were significantly higher for PCI in the setting of an abnormal fractional flow reserve than with medical therapy( ¥ 59670 vs. ¥ 23970,P <0. 01),but the ¥ 36880 difference narrowed over 1 - year follow - up to ¥ 15230(P < 0. 001),mostly because of the cost of subsequent revascularization procedures. Patient utility was improved more at 1 month with PCI than with medical therapy (0. 054 versus 0. 001 units,P < 0. 001). Conclusions:PCI of coronary lesions with reduced FFR improves outcomes and appears economically attractive compared with best medical therapy among patients with stable coronary artery disease.