经皮冠状动脉介入治疗后的心绞痛：患者和操作程序预测因素。
Angina After Percutaneous Coronary Intervention: Patient and Procedural Predictors.
机构信息
West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (D.C., R.M., M.D., M.A.R., P.M., M.L., A.S., P.R., R.B., S.W., M.M., R.G., K.R., P.O., A.D., A.K., S.H., H.E., C.B., K.G.O.).
Institute of Cardiovascular & Medical Sciences, University of Glasgow, United Kingdom (D.C., P.M., T.J.F., S.W., M.M., R.G., H.E., C.B., K.G.O.).
出版信息
Circ Cardiovasc Interv. 2023 Apr;16(4):e012511. doi: 10.1161/CIRCINTERVENTIONS.122.012511. Epub 2023 Mar 28.
BACKGROUND
Twenty percent to 40% of patients are affected by angina after percutaneous coronary intervention (PCI), which is associated with anxiety, depression, impaired physical function, and reduced quality of life. Understanding patient and procedural factors associated with post-PCI angina may inform alternative approaches to treatment.
METHODS
Two hundred thirty patients undergoing PCI completed the Seattle Angina Questionnaire (SAQ-7) and European quality of life-5 dimension-5 level (EQ-5D-5L) questionnaires at baseline and 3 months post-PCI. Patients received blinded intracoronary physiology assessments before and after stenting. A post hoc analysis was performed to compare clinical and procedural characteristics among patients with and without post-PCI angina (defined by follow-up SAQ-angina frequency score <100).
RESULTS
Eighty-eight of 230 patients (38.3%) reported angina 3 months post-PCI and had a higher incidence of active smoking, atrial fibrillation, and history of previous myocardial infarction or PCI. Compared with patients with no angina at follow-up, they had lower baseline SAQ summary scores (69.48±24.12 versus 50.20±22.59, <0.001) and EQ-5D-5L health index scores (0.84±0.15 versus 0.69±0.22, <0.001). Pre-PCI fractional flow reserve (FFR) was lower among patients who had no post-PCI angina (0.56±0.15 versus 0.62±0.13, =0.003). Percentage change in FFR after PCI had a moderate correlation with angina frequency score at follow-up (=0.36, <0.0001). Patients with post-PCI angina had less improvement in FFR (43.1±33.5% versus 67.0±50.7%, <0.001). There were no between-group differences in post-PCI FFR, coronary flow reserve, or corrected index of microcirculatory resistance. Patients with post-PCI angina had lower SAQ-summary scores (64.01±22 versus 95.16±8.72, ≤0.001) and EQ-5D-5L index scores (0.69±0.26 versus 0.91±0.17, ≤0.001) at follow-up.
CONCLUSIONS
Larger improvements in FFR following PCI were associated with less angina and better quality of life at follow-up. In patients with stable symptoms, intracoronary physiology assessment can inform expectations of angina relief and quality of life improvement after stenting and thereby help to determine the appropriateness of PCI.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT03259815.
背景
经皮冠状动脉介入治疗（PCI）后，20%至 40%的患者会出现心绞痛，这与焦虑、抑郁、身体功能受损和生活质量下降有关。了解与 PCI 后心绞痛相关的患者和程序因素可能有助于为治疗提供替代方法。
方法
230 名接受 PCI 的患者在基线和 PCI 后 3 个月时完成西雅图心绞痛问卷（SAQ-7）和欧洲生活质量-5 维度-5 级（EQ-5D-5L）问卷。患者在支架置入前后接受了盲法冠状动脉生理学评估。对有和无 PCI 后心绞痛（根据随访 SAQ-心绞痛频率评分<100 定义）的患者进行了事后分析，以比较临床和程序特征。
结果
230 名患者中有 88 名（38.3%）报告 PCI 后 3 个月出现心绞痛，且吸烟、心房颤动以及既往心肌梗死或 PCI 史的发生率较高。与随访时无心绞痛的患者相比，他们的基线 SAQ 综合评分较低（69.48±24.12 与 50.20±22.59，<0.001），EQ-5D-5L 健康指数评分较低（0.84±0.15 与 0.69±0.22，<0.001）。无 PCI 后心绞痛的患者的 PCI 前血流储备分数（FFR）较低（0.56±0.15 与 0.62±0.13，=0.003）。PCI 后 FFR 的变化百分比与随访时的心绞痛频率评分呈中度相关（=0.36，<0.0001）。有 PCI 后心绞痛的患者 FFR 的改善程度较低（43.1±33.5% 与 67.0±50.7%，<0.001）。PCI 后 FFR、冠状动脉血流储备和校正的微血管阻力指数在两组之间无差异。有 PCI 后心绞痛的患者的 SAQ 综合评分较低（64.01±22 与 95.16±8.72，≤0.001），EQ-5D-5L 指数评分较低（0.69±0.26 与 0.91±0.17，≤0.001）。
结论
PCI 后 FFR 的更大改善与随访时更少的心绞痛和更好的生活质量相关。在症状稳定的患者中，冠状动脉生理学评估可以为支架置入后缓解心绞痛和改善生活质量的预期提供信息，并有助于确定 PCI 的适宜性。
注册
网址：https://www.
临床试验
gov；独特标识符：NCT03259815。
Zotero 插件