定量血流分数指导下经皮腔内冠状动脉介入治疗伴多支血管病变超高龄急性冠状动脉综合征患者的临床效果

目的  探究定量血流分数（QFR）指导下经皮腔内冠状动脉介入（PCI）治疗伴多支血管病变超高龄急性冠状动脉综合征（ACS）患者的临床效果。方法  选取2019年3月~2020年4月在我院接受治疗并符合纳入标准拟行急性冠状动脉综合征超高龄患者（90~110岁）80例为研究对象，根据患者意愿分为研究组及对照组，40例/组。对照组采用单纯冠状动脉造影诊断PCI手术治疗；研究组采用QFR指导PCI。检测术前及术后1月患者血浆脑利钠肽、氨基末端B型利钠肽前体、心肌肌钙蛋白I水平，心脏功能指标（左心室射血分数、左心室舒张末期内径、左心室收缩末期内径、射血分数）、纽约心脏病协会分级变化及不良事件发生情况。结果  研究组冠状动脉造影血管直径狭窄程度≥50%共83支，其中QFR≤0.8阳性43支（51.81%），阴性40支（48.19%），其中阳性41支、阴性7支行PCI联合冠状动脉旁路移植术治疗，与QFR分析结果相符率分别为95.35%、82.50%；对照组冠状动脉造影血管直径狭窄程度≥50%共79支，其中70支病变血管行PCI联合冠状动脉旁路移植术治疗。术后1月研究组血浆脑利钠肽、氨基末端B型利钠肽前体水平、左心室收缩末期内径、左心室舒张末期内径均低于对照组，射血分数值高于对照组（P < 0.05）；研究组术后1月内不良事件发生率低于对照组（27.50% vs 50.00%，P < 0.05）。结论  QFR指导外科PCI手术治疗超高龄多支血管病变的急性冠状动脉综合征安全可行，可降低术后不良事件发生率，但其有效性仍需进一步扩大样本和进行前瞻性临床研究验证。

Clinical effect of percutaneous transluminal coronary intervention in the treatment of very elderly patients with acute coronary syndrome with multivessel disease under the guidance of quantitative flow ratio

  Objective  To explore the clinical effects of percutaneous transluminal coronary intervention (PCI) under the guidance of quantitative blood flow fraction (QFR) in the treatment of very elderly patients with acute coronary syndrome with multivessel disease.  Methods  Eighty super-aged patients who were treated in our hospital from March 2019 to April 2020 and met the inclusion criteria and planned to undergo acute coronary syndrome were selected as the research objects. They were divided into observation group and control group, with 40 cases in each group. The control group used coronary angiography alone to diagnose PCI surgery. The observation group used QFR to guide PCI. The plasma brain natriuretic peptide, NT-proBNP, cardiac troponin I levels, changes in cardiac function indicators before and after surgery (left ventricular ejection fraction, left ventricular end diastolic diameter, left ventricular end systolic diameter, ejection fraction), NYHA grading changes and adverse events were detected.  Results  The observation group had 83 coronary angiography vessel diameter stenosis≥50%, of which 43 were positive for QFR≤0.8 (51.81%) and 40 were negative (48.19%). Among them, 41 positive and 7 negative were treated with PCI combined with coronary artery revascularization surgery, which was consistent with the results of QFR analysis. The rates were 95.35% and 82.50%, respectively. The control group had 79 vessels with coronary angiography vessel diameter stenosis≥50%, 70 of which were treated with PCI combined with coronary artery revascularization. The plasma brain natriuretic peptide of the observation group was 1 month after the operation. The levels of NT- proBNP, left ventricular end systolic diameter and left ventricular end diastolic diameter were significantly lower than those of the control group, and the ejection fraction value was higher than that of the control group (P < 0.05). The adverse event rate of 27.50% (n=11) in observation group was significantly lower than that of control group within 1 month after surgery 50.00% (n=20, P < 0.05).  Conclusion  Quantitative blood flow scores are safe and feasible to guide surgical percutaneous coronary intervention in the treatment of acute coronary syndrome in very elderly patients with multivessel disease. It can reduce the incidence of postoperative adverse events. However, its effectiveness still needs to be further expanded and validated by prospective clinical studies.