血浆高敏C反应蛋白对冠状动脉介入术后早期并发症及再狭窄的预测价值

目的　探讨心绞痛患者行经皮冠状动脉介入治疗 (PCI)前 ,高敏C 反应蛋白 (hs CRP)水平对早期并发症及术后再狭窄的预测价值。方法　对 12 0例心绞痛的患者 (5 2例稳定型心绞痛 ,6 8例不稳定型心绞痛 )入院时测定血浆hs CRP水平 ,然后行单支血管的经皮冠状动脉腔内成形术(PTCA) ,随访 1年 ,观察早期并发症及晚期再狭窄发生率 ,对其进行分析。结果　 12 0例患者中 ,血浆hs CRP升高者 6 8人 ,早期并发症均发生在高hs CRP水平者。再狭窄发生率为 4 6 % ,其中血浆hs CRP正常者 14例 ,占 2 7% ;血浆hs CRP升高者 37例 ,占 6 3% (P <0 0 0 1)。经多因素回归分析显示 ,术前CRP水平增高 (r=11 7,P <0 0 0 1)、高血压 (r=4 3,P =0 0 3)、女性 (r=4 1,P =0 0 13)是预测早期并发症的独立危险因素 ,而高CRP(r=6 7,P <0 0 0 1)及术后残余狭窄 (r=3 2 ,P =0 0 0 7)是预测再狭窄的独立危险因素。结论　血浆hs CRP水平可作为炎症标志物反映冠状动脉炎症情况 ,对PTCA早期并发症及术后再狭窄有一定的预测价值。     

Usefulness of coronary pressure measurement for functional evaluation of drug-eluting stent restenosis

Despite the widespread adoption of drug-eluting stent (DES) implantation, the optimal treatment of DES failures remains challenging. The present study evaluated the relation between quantitative angiography and the fractional flow reserve (FFR) in restenotic lesions after DES implantation and the efficacy of FFR in determining whether to treat these lesions. To assess their functional significance, the coronary pressure-derived FFR was measured in 50 DES restenotic lesions (49 patients). Additional intervention was performed in lesions with a FFR <0.8. Major adverse cardiac events were assessed at 12 months after the reintervention procedure. The mean percent diameter stenosis (%DS) was 58 ± 13%. Of the 50 lesions, 20 (40%) were deferred without additional intervention. The FFR and %DS had a negative correlation (r = -0.61, p <0.001). However, when only the lesions with diffuse-type restenosis (15 lesions) were analyzed, the degree of correlation decreased (r = -0.56, p = 0.12). Although most lesions (89%) with a %DS of ≥70 had significant functional ischemia, among 41 lesions with a %DS <70, only 20 (49%) had demonstrated functional patency. The incidence of adverse events during the 12 months of follow-up after FFR-guided treatment was 18.0% (23.3% in the FFR <0.80 group and 10.0% in FFR ≥0.80 group). In conclusion, a discrepancy was found between functional ischemia measured by the FFR and the angiographic %DS, in particular, in moderate- or diffuse-type restenotic lesions after DES implantation. The outcome of FFR-guided deferral in patients with DES in-stent restenosis seems favorable.