摘要
目的探讨非急性心肌梗死患者经皮冠状动脉介入治疗(PCI)术后定量血流分数(QFR)对术后3年主要不良心血管事件(MACE)发生的预测价值。方法本研究纳入厦门大学附属心血管病医院心脏导管室2020年1-6月行PCI的139例非急性心肌梗死患者,术后均测量靶血管QFR值,并随访患者术后3年MACE发生情况。通过受试者工作特征(ROC)曲线计算出QFR截断值,根据截断值将患者分成QFR>0.95组和QFR≤0.95组,根据是否发生MACE分成MACE组和非MACE组。通过单因素及多因素线性回归分析探讨非急性心肌梗死患者PCI术后QFR的独立影响因素,采用单因素及多因素Cox回归分析探讨PCI术后QFR对非急性心肌梗死患者术后3年MACE发生的预测价值。通过绘制无MACE生存曲线对比QFR>0.95组和QFR≤0.95组患者远期预后。结果通过ROC曲线分析得出PCI术后QFR预测非急性心肌梗死患者术后3年MACE发生有统计学意义(AUC 0.666,95%CI 0.556~0.777,P=0.003),且预测MACE发生的截断值为0.95,根据截断值将患者分为QFR≤0.95组(74例)和QFR>0.95组(65例)。多因素线性回归分析显示,PCI术后最大支架面积狭窄率是术后QFR的独立影响因素(P<0.001)。多因素Cox回归分析显示身体质量指数(BMI)、术后QFR、三支血管病变、术后QFR分组是无MACE生存期的独立影响因素。无MACE生存曲线显示:QFR>0.95组患者远期预后明显优于QFR≤0.95组(χ^(2)=5.272,P=0.022)。结论PCI术后QFR预测非急性心肌梗死患者术后3年MACE发生的最佳截断值为0.95,且术后QFR≤0.95的患者远期预后较差。BMI、三支血管病变、术后QFR≤0.95是非急性心肌梗死患者PCI术后3年MACE发生的独立危险因素。
Objective To investigate the predictive value of quantitative f low ratio(QFR)on the occurrence of major adverse cardiovascular events(MACE)3 years af ter percu ta neous corona r y inter vention(PCI)in patients wit h non-acu te m yoca rdial infarction.Methods This study included 139 patients with non-acute myocardial infarction who underwent PCI from January 2020 to June 2020 in the cardiac catheterization room of our hospital,all of them underwent post-PCI target vessel QFR measurements,and the incidence of MACE was followed up 3 years after PCI.The cut-off value of QFR was calculated by receiver operating characteristic(ROC)curve,according to which patients were divided into QFR>0.95 group and QFR≤0.95 group,and patients were divided into MACE group and non-MACE group depending on whether MACE occurs.The independent influencing factors of post-PCI QFR in patients with non-acute myocardial infarction were investigated by univariate and multif actorial linear regression analysis.Univariate and multivariate Cox regression analysis was used to investigate the predictive value of post-PCI QFR in the occurrence of MACE 3 years after PCI in patients with non-acute myocardial infarction.The long-term prognosis of patients with QFR>0.95 and those with QFR≤0.95 was compared by drawing the survival cur ve of no-MACE event.Results ROC curve analysis showed that post-PCI QFR predicted the occurrence of MACE 3 years after surgery in non-acute myocardial infarction patients with statistical significance(AUC 0.666,95%CI 0.556–0.777,P=0.003),and the cut-off value of MACE was 0.95.The sensitivity and specificity were 75.00%and 51.30%for the diagnosis of MACE with QFR≤0.95.Patients were divided into QFR≤0.95 group(n=74)and QFR>0.95 group(n=65)according to the cut-off v alue.Mul tivariate linear regression analysis showed that the maximum area stenosis rate after PCI was an independent factor for post-PCI QFR(P<0.001).Multivariate Cox regression analysis showed that body mass index(BMI),post-PCI QFR,three-vessel lesions and post-PCI QFR groups were independent influencing factors of no-MACE lifetime.The no-MACE survival curve showed that the long-term prognosis of patients in the QFR>0.95 group was significantly better than that in the QFR≤0.95 group(χ^(2)=5.272,P=0.022).Conclusions The optimal cut-off value of post-PCI QFR for predicting the occurrence of MACE 3 years after PCI in non-acute myocardial infarct ion patients was 0.95,and patients with QFR≤0.95 had worse long-term prognosis,and BMI,three-vessel lesions,and post-PCI QFR≤0.95 were independent risk factors for the occu rrence of MACE 3 years in non-acute myocardial infarction patients after PCI.
作者
柏中胜
肖栋
彭朝梅
曹龙兴
张小敏
肖国胜
BAI Zhong-sheng;XIAO Dong;PENG Chao-mei;CAO Long-xing;ZHANG Xiao-min;XIAO Guo-sheng(Department of Cardiology,the Affiliated Cardiovascular Hospital of Xiamen University,Xiamen 361006,China)
出处
《中国介入心脏病学杂志》
CSCD
2023年第12期894-903,共10页
Chinese Journal of Interventional Cardiology
关键词
经皮冠状动脉介入治疗
定量血流分数
非急性心肌梗死
主要不良心血管事件
Percutaneous coronary intervention
Quantitative flow ratio
Non-acute myocardial infarction
Major adverse cardiovascular events
