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目的应用血流储备分数(FFR)对冠状动脉主支介入治疗前后受累的分叉病变进行功能评估。方法选择2014年7月至2016年6月60例行冠状动脉主支介入治疗时行冠脉造影显示有分叉病变的冠心病患者,根据Medina分型法将患者分为观察组37例(真性分叉病变)和对照组23例(假性分叉病变)。两组患者均在主支行PCI并植入雷帕霉素药物洗脱支架,在主支支架植入前后使用冠状动脉造影定量分析(QCA)和血流储备分数(FFR)对分叉血管进行解剖和功能评估,并对患者的FFR下降因素进行Logistic回归分析。结果观察组分支血管在主支PCI术前后狭窄程度(直径狭窄,DS)[(66.8±11.4)%vs(72.7±11.8)%]及FFR(0.81±0.12 vs 0.73±0.12)差异均有统计学意义(P均<0.05),提示分支血管的功能较术前明显下降;对照组均无明显变化(P均<0.05)。Logistic多因素分析显示,分支血管的直径<2 mm、狭窄≥70%以及病变长度≥10 mm是主支PCI术后分支血管FFR值下降的危险因素(P均<0.05)。结论真性分叉病变的分支血管在主支植入支架后功能明显降低;受累分支小直径,严重狭窄和长病变是功能下降的相关危险因素。在主支介入治疗时可以依据分支血管FFR值采用最适用的方案,从而优化冠状动脉介入术。
Objective To evaluate the functional status of bifurcation lesions before and after interventional therapy of coronary artery by flow fraction reserve (FFR). Methods From July 2014 to June 2016, 60 patients with coronary artery disease underwent coronary angiography showed coronary artery disease with bifurcation lesions. According to the method of Medina classification, the patients were divided into observation group (37 cases) Bifurcation lesions) and control group 23 cases (pseudo-bifurcation lesions). Both groups underwent primary PCI and implantation of a rapamycin-eluting stent. Anatomy of the bifurcation vessel using coronary angiography (QCA) and flow reserve (FFR) before and after stent implantation And functional assessment, and logistic regression analysis of FFR decline factors in patients. Results The differences of the degree of stenosis (diameter stenosis, DS) [(66.8 ± 11.4)% vs (72.7 ± 11.8)%] and FFR (0.81 ± 0.12 vs 0.73 ± 0.12) (All P <0.05), suggesting that the functions of the branch vessels decreased significantly compared with that before the operation. There was no significant difference in the control group (all P <0.05). Logistic multivariate analysis showed that the diameters of branch vessels <2 mm, stenosis ≥70% and lesion length ≥10 mm were the risk factors for the decrease of FFR in branch vessels after PCI (all P <0.05). Conclusions The function of branch vessels in patients with true bifurcation lesion is significantly reduced after stent implantation. Small diameter branches, severe stenosis and long lesions are the related risk factors of functional decline. In the main branch of interventional therapy can be based on branch-line FFR values using the most appropriate program to optimize coronary intervention.