冠状动脉微循环阻力指数联合冠状动脉血流储备分数在稳定型心绞痛患者随访中的应用

目的 通过测定冠状动脉血流储备分数（FFR）和冠状动脉微循环阻力指数（IMR）评估稳定型心绞痛患者的心外膜及微循环功能，并根据FFR＞0.83及IMR≥25界值对患者进行分组随访，以明确不同组别患者的预后。方法纳入FFR＞0.75未接受经皮冠状动脉介入治疗（PCI）术的稳定型心绞痛患者422例，进一步测量IMR值、冠状动脉血流储备值(CFR)。根据是否IMR值≥25 U及FFR值>083分成4组，A组（IMR＜25 U及FFR＞0.83）、B组（IMR≥25 U及0.75＜FFR≤0.83）、C组（IMR≥25 U及FFR＞0.83）、D组（IMR＜25 U及075＜FFR≤0.83），其中A组为对照组。所有入选患者均按照指南正规服用药物治疗。患者出院当天即开始随访，出院后2周以后每月随访1次，如病情变化随时就诊，随访截止日期2020年8月31日。比较不同组别之间的临床资料和预后情况。结果年龄、高血压病比例、Gensini积分、HDL-C、LDL-C、CFR值、Hcy 4组间比较差异有统计学意义（P<0.05）。进一步组间比较，B组患者年龄、高血压病比例、Gensini积分、LDL-C和Hcy较对照组高，HDL-C及CFR值较对照组低（P<0.05）。C组患者年龄及Hcy水平较对照组高(P<0.05)。D组患者HDL-C水平及Gensini积分较对照组高（P<0.05）。B组患者生存时间较对照组明显降低（P<0.05），且MACE事件发生率较对照组明显升高(P<0.05)。C组、D组MACE事件发生率与对照组比较差异无统计学意义（P>0.05）。

Follow-up analysis of patients with stable angina pectoris based on index of microcirculatory resistance and fractional flow reserve

Objective To evaluate the epicardial and microcirculation function in patients with stable angina by measuring fractional flow reserve (FFR) and index of microcirculatory resistance (IMR), and to group and follow up patients according to FFR>083 and IMR>25 to determine the prognosis of patients among different groups. Methods The subjects of this study were stable angina patients with FFR>075 who did not undergo percutaneous coronary intervention (PCI), and IMR and CFR values were further measured. According to whether the IMR value>25 and the FFR value>083 were divided into 4 groups (Group A, B, C and D), and Group A was the control group. All the patients were treated according to the guidelines. Patients were followed up regularly on the day of discharge, 2 weeks after discharge, and once a month. If the condition changes, he will be treated at any time, the follow-up deadline was August 31, 2020. Clinical data and prognosis were compared among different groups. Results A total of 422 patients with stable angina were enrolled in the study. There were 115 cases in Group A (IMR<25 U and FFR>083), 98 cases in Group B (IMR≥25 U and 075083), and 108 cases in Group D (IMR<25 U and 075005). Multivariate Cox regression analysis showed that elevated CFR may be a protective factor for MACE events; and Gensini score, IMR values ≥25 U and 075 083) (P=0004). Conclusion When patients with stable angina with the FFR values in the range of 075-083, in addition to considering the clinical situation of patients and the importance of blood supply, further measurement of IMR values can help for risk stratification of patients in the gray area and provide a reference for treatment strategies.