稳定型冠状动脉疾病患者冠状动脉血运重建对整体冠状动脉血流储备的影响。

Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease.

机构信息

Department of Cardiovascular Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan.

Department of Nuclear Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan.

出版信息

Cardiovasc Res. 2019 Jan 1;115(1):119-129. doi: 10.1093/cvr/cvy169.

AIMS

Coronary flow reserve (CFR) is an integrated measure of the entire coronary vasculature, and is a powerful prognostic marker in coronary artery disease (CAD). The extent to which coronary revascularization can improve CFR is unclear. This study aimed to evaluate the impact of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on CFR in patients with stable CAD.

METHODS AND RESULTS

In a prospective, multicentre observational study, CFR was measured by 15O-water positron emission tomography as the ratio of stress to rest myocardial blood flow at baseline and 6 months after optimal medical therapy (OMT) alone, PCI, or CABG. Changes in the SYNTAX and Leaman scores were angiographically evaluated as indicators of completeness of revascularization. Follow-up was completed by 75 (25 OMT alone, 28 PCI, and 22 CABG) out of 82 patients. The median SYNTAX and Leaman scores, and baseline CFR were 14.5 [interquartile range (IQR): 8-24.5], 5.5 (IQR: 2.5-12.5), and 1.94 (IQR: 1.67-2.66), respectively. Baseline CFR was negatively correlated with the SYNTAX (ρ = -0.40, P < 0.001) and Leaman scores (ρ = -0.33, P = 0.004). Overall, only CABG was associated with a significant increase in CFR [1.67 (IQR: 1.14-1.96) vs. 1.98 (IQR: 1.60-2.39), P < 0.001]. Among patients with CFR <2.0 (n = 41), CFR significantly increased in the PCI [1.70 (IQR: 1.42-1.79) vs. 2.21 (IQR: 1.78-2.49), P = 0.002, P < 0.001 for interaction between time and CFR] and CABG groups [1.28 (IQR: 1.13-1.80) vs. 1.86 (IQR: 1.57-2.22), P < 0.001]. The reduction in SYNTAX or Leaman scores after PCI or CABG was independently associated with the percent increase in CFR after adjusting for baseline characteristics (P = 0.012 and P = 0.011, respectively).

CONCLUSION

Coronary revascularization ameliorated reduced CFR in patients with obstructive CAD. The degree of improvement in angiographic CAD burden by revascularization was correlated with magnitude of improvement in CFR.

目的

冠状动脉血流储备（CFR）是整个冠状动脉血管的综合测量指标，是冠心病（CAD）的强有力预后标志物。冠状动脉血运重建能在多大程度上改善 CFR 尚不清楚。本研究旨在评估经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）对稳定型 CAD 患者 CFR 的影响。

方法和结果

在一项前瞻性、多中心观察性研究中，通过 15O-水正电子发射断层扫描（PET）测量 CFR，作为基线和最佳药物治疗（OMT）后应激与静息心肌血流的比值，OMT 单独、PCI 或 CABG。通过血管造影评估 SYNTAX 和 Leaman 评分的变化作为血运重建完全程度的指标。82 例患者中，75 例完成了随访（单独 OMT 25 例、PCI 28 例和 CABG 22 例）。中位 SYNTAX 和 Leaman 评分以及基线 CFR 分别为 14.5[四分位距（IQR）：8-24.5]、5.5（IQR：2.5-12.5）和 1.94（IQR：1.67-2.66）。基线 CFR 与 SYNTAX（ρ=-0.40，P<0.001）和 Leaman 评分（ρ=-0.33，P=0.004）呈负相关。总体而言，只有 CABG 与 CFR 的显著增加相关[1.67（IQR：1.14-1.96）比 1.98（IQR：1.60-2.39），P<0.001]。在 CFR<2.0 的患者中（n=41），PCI 组 CFR 显著增加[1.70（IQR：1.42-1.79）比 2.21（IQR：1.78-2.49），P=0.002，P<0.001 用于 CFR 与时间之间的交互作用]和 CABG 组[1.28（IQR：1.13-1.80）比 1.86（IQR：1.57-2.22），P<0.001]。PCI 或 CABG 后 SYNTAX 或 Leaman 评分的降低与 CFR 增加百分比独立相关，在调整基线特征后（P=0.012 和 P=0.011）。