【摘要】 目的:观察不适合冠状动脉(冠脉)旁路移植术(CABG)的SYNTAX评分≥33分冠心病患者在血流储备分数(FFR)指导下行经皮冠脉介入治疗(PCI)的近、远期临床疗效治疗。方法:收集2012-01至2015-06期间SYNTAX评分≥33分且EuroS CORE评分>6分的冠心病患者共117例。经心脏团队会诊认为不适合外科手术,分为单纯药物治疗(药物治疗组,n=20)和PCI(PCI组,n=97)。其中PCI组在FFR指导下PCI术,术中根据术者经验选择旋磨和(或)血管内超声检查。所有患者随访至少12个月。同时以"冠脉支架+搭桥"、"CABG+PCI"为主题词检索2012-01-01至2015-12-31内的维普中文科技期刊全文数据库、万方医学数据库、中国知网和中国生物医学文献数据库的相关文献,将本中心的研究结果与其进行比较以了解临床获益情况。结果:(1)PCI组和药物治疗组SYNTAX评分和Euro SCORE评分基本一致,差异无统计学意义(P>0.05)。病变方面,均以左前降支受累为常见。而在部分血运重建的患者中,慢性闭塞病变所占比例较多,占31.3%(5/16)。(2)PCI组共发生主要不良心脑血管事件(MACCE)共18例,发生率18.6%(18/97),其中随访期死亡2例,再次血运重建9例。药物治疗组发生MACCE共12例,发生率60.0%(12/20),其中随访期死亡3例。两者比较差异有统计学意义(P<0.05)。PCI术中并发症并无明显增加。(3)检索到同时期临床研究共22项。本中心PCI组MACCE发生率与22项研究报道的MACCE发生率差异无统计学意义(P>0.05),药物治疗组的MACCE发生率明显增加(P<0.05)。结论:对于不适合CABG的SYNTAX积分≥33分的冠心病患者在FFR指导下行PCI治疗可以带来临床获益。更多还原

【Abstract】 Objective:To observe the short-and long-term clinical outcomes of fraction flow reserve(FFR)-guided percutaneous coronary intervention(PCI) in coronary artery disease(CAD) patients with SYNTAX score≥33 unsuitable for coronary artery bypass grafting(CABG).Methods:A total of 117 CAD patients admitted in our hospital from 2012-01 to 2015-06 were enrolled.Since SYNTAX score≥33,EuroS CORE>6,the patients were unsuitable for CABG and treated in 2 groups:Medication group,n=20 and PCI group,during FFR-guided PCI procedure,patients received ROTA or IVUS according to physician’s experience,n=97.All patients were followed-up for at least 12 months.Meanwhile,taking "coronary stent and bypass","CABG and PCI" as key words,we searched relevant documents in VIP Chinese science and technology journal full-text database,WanF ang medical database,ChinaN et and Chinese biomedical literature database from 2012-01-01 to 2015-12-31,patients’ outcomes were compared with the above references to explore the clinical benefit.Results:(1) PCI group and Medication group had similar SYNTAX score and Euro SCORE,P >0.05.The common pathogenesis was LAD involvement,chronic occlusion was 31.3%(5/16) in patients with partial revascularization.(2) PCI grouphad 18.6%(18/97) incidence of major adverse cardiac and cerebral events(MACCE),2 patients died during follow-up period and 9 received revascularization;Medication group had 60%(12/20) incidence of MACCE,3 patients died during follow-up period;the difference between 2 groups showed statistical meaning,P<0.05.(3) There were 22 relevant documents retrieved as comparison;in our research,PCI group had similar incidence of MACCE to the documents,P>0.05;Medication group had increased incidence of MACCE than the documents,P<0.05.Conclusion:FFR-guided PCI could bring clinical benefit in CAD patients with SYNTAX score≥33 unsuitable for CABG.更多还原