摘要
目的 探讨定量血流分数(QFR)评估药物洗脱支架(DES)联合药物涂层球囊(DCB)治疗原位冠状动脉弥漫病变的效果及对预后影响。方法 单中心、回顾性研究。连续选取2017年2月至2021年11月在中国医学科学院阜外医院确诊为原位冠状动脉弥漫病变并接受DES联合DCB治疗的109例患者,其中男性78例,占比71.6%。术后应用QFR评估靶血管,以QFR值0.90为截断值,分为QFR≥0.90组和QFR<0.90组。随访记录主要不良心血管事件(MACE),包括心原性死亡、心肌梗死(包括围手术期心肌梗死)和靶血管血运重建。结果 109例患者的114处靶病变接受治疗,术后平均QFR值为0.91±0.06。与QFR≥0.90组(77处)比较,QFR<0.90组(37处)DCB治疗段术前参考血管直径[(2.23±0.26) mm比(2.35±0.29) mm,F=0.600,P=0.028]和最小管腔直径[(0.38±0.14)mm比(0.46±0.19)mm,F=4.614,P=0.030]更小、病变长度更长[(26.00±10.10)mm比(22.01±8.01)mm,F=2.136,P=0.024],术后最小管腔直径[(1.73±0.29) mm比(1.96±0.28)mm,F=0.322,P<0.001]和即刻管腔获得直径[(1.35±0.28) mm比(1.51±0.24) mm,F=0.722,P=0.003]更小、残余狭窄率更高(22.46%±7.78%比16.45%±6.23%,F=4.059,P<0.001)、QFR值更低(0.84±0.35比0.93±0.02,F=1.234,P<0.001)。多因素logistic回归分析显示,DCB治疗段术后残余狭窄率是QFR值降低的独立危险因素(OR=1.128,95%CI:1.055~1.205,P<0.001)。Kaplan-Meier生存分析显示,排除围手术期心肌梗死后,QFR<0.90组经皮冠状动脉介入治疗术后2年预估的MACE发生率高于QFR≥0.90组(12.1%±5.7%比5.6%±4.4%,log-rank P=0.035)。结论 在接受DES联合DCB治疗的原位冠状动脉弥漫病变患者中,术后低QFR值与远期预后不良相关。
Objective To assess the efficacy and prognosis of quantitative flow ratio(QFR)-guided treatment with drug-eluting stent(DES)and drug-coated balloon(DCB)for de novo diffuse coronary artery disease.Methods This single-center retrospective study included 109 consecutive patients diagnosed with de novo diffuse coronary artery disease who underwent DES combined with DCB treatment at Fuwai Hospital,Chinese Academy of Medical Sciences,between February 2017 and November 2021.There were 71.6%of male(78/109).Based on a post-procedural QFR cut-off value of 0.90,lesions were categorized into the QFR≥0.90 group and the QFR<0.90 group.Major adverse cardiovascular events(MACEs),including cardiac death,myocardial infarction(MI)(including peri-procedural MI),and target vessel revascularization(TVR),were recorded during follow-up.Results There were 114 lesions from 109 patients underwent treatment.The mean post-procedural QFR value for the 114 lesions was 0.91±0.06.Compared to those in QFR≥0.90 group(77 lesions),patients in QFR<0.90 group(37 lesions)had significantly smaller pre-procedural reference vessel diameter[(2.23±0.26)mm vs.(2.35±0.29)mm,F=0.600,P=0.028]and minimal lumen diameter[(0.38±0.14)mm vs.(0.46±0.19)mm,F=4.614,P=0.030]within the DCB-treated segment,longer lesion length[(26.00±10.10)mm vs.(22.01±8.01)mm,F=2.136,P=0.024],smaller post-procedural minimal lumen diameter[(1.73±0.29)mm vs.(1.96±0.28)mm,F=0.322,P<0.001],smaller immediate lumen gain[(1.35±0.28)mm vs.(1.51±0.24)mm,F=0.722,P=0.003],higher residual stenosis rate(22.46%±7.78%vs.16.45%±6.23%,F=4.059,P<0.001),and lower QFR value(0.84±0.35 vs.0.93±0.02,F=1.234,P<0.001).Multivariate logistic regression analysis identified the residual stenosis rate in the DCB-treated segment as an independent risk factor for reduced QFR(OR=1.128,95%CI:1.055-1.205,P<0.001).Kaplan-Meier survival analysis revealed that,after excluding peri-procedural MI,patients with QFR<0.90 had a significantly higher estimated cumulative incidence of MACEs within 2 years of intervention compared to those with QFR≥0.90(12.1%±5.7%vs.5.6%±4.4%,log-rank P=0.035).Conclusions In patients with de novo diffuse coronary artery disease treated with DES combined with DCB,a low post-procedural QFR value is associated with poor long-term prognosis.
作者
潘崇
许浩博
翟关群
朱法胜
张体鹏
龙广宇
袁建松
胡奉环
崔锦钢
王全河
Pan Chong;Xu Haobo;Zhai Guanqun;Zhu Fasheng;Zhang Tipeng;Long Guangyu;Yuan Jiansong;Hu Fenghuan;Cui Jingang;Wang Quanhe(Department of Cardiology,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007,China;Department of Cardiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)
出处
《中国心血管杂志》
2025年第5期494-501,共8页
Chinese Journal of Cardiovascular Medicine
关键词
定量血流分数
药物洗脱支架
药物涂层球囊
原位冠状动脉弥漫病变
预后
Quantitative flow ratio
Drug-eluting stent
Drug-coated balloon
de novo diffuse coronary artery disease
Prognosis
作者简介
通信作者:崔锦钢,电子信箱:jgc1974@163.com;通信作者:王全河,电子信箱:qhwang7706@163.com。
