2025 年第 9 期 第 20 卷

冠状动脉支架植入即刻分支开口面积减小的危险因素研究

Study on risk factors for reduction of branch opening area after immediate of coronary stent implantation

作者：殷维钧刘巍杨文涛兰永昊

英文作者：Yin Weijun Liu Wei Yang Wentao Lan Yonghao

单位：首都医科大学附属北京积水潭医院心内科，北京100000

英文单位：Department of Cardiology Beijing Jishuitan Hospital Capital Medical University Beijing 100000 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；腔内影像；分叉病变；经皮冠状动脉介入

英文关键词：Coronaryatheroscleroticheartdisease;Intracavitaryimaging;Bifurcationlesions;Percutaneouscoronaryintervention

• 摘要：

• 目的 应用高精度的腔内影像学技术和功能学相结合，探究冠状动脉支架植入即刻分支开口面积减小的危险因素。方法 选取2022年10月22日至2023年6月1日于首都医科大学附属北京积水潭医院行冠状动脉造影及支架介入治疗的患者，以腔内影像测量的术后分支开口面积减小比例超过50%为标准，将病变分为术后分支开口面积减小组(53例)和术后分支开口面积正常组（113例），比较2组病变的各项造影特征、腔内影像指标的差异，并测量分叉病变主支各位点的虚拟冠状动脉血流储备分数（Angio-FFR）。分析术后分支开口面积减小的独立危险因素。并建立受试者工作特征（ROC）曲线评估腔内影像对于分支开口面积减小的预测价值。结果 2组冠状动脉造影资料比较差异均无统计学意义（均P＞0.05）。开口面积减小组斑块破裂/侵蚀、愈合斑块、钙化比例均低于开口面积正常组，分叉角度、分叉核最小管腔面积均小于开口面积正常组（均P＜0.05）。ROC曲线分析结果显示跨分叉ΔAngio-FFR预测分支开口面积减小的曲线下面积为0.80（P<0.001）。多因素Logistic回归分析结果显示，愈合斑块、分叉钙化、跨分叉ΔAngio-FFR均为分支开口面积减小的危险因素（均P＜0.05）。结论 分叉交汇区的愈合斑块、分叉钙化和跨分叉ΔAngio-FFR是术后分支开口面积减小的危险因素，跨分叉血管段ΔAngio-FFR≥0.04能较好地预测支架术后分支开口面积减小。

• Objective To explore the risk factors for reduction in branch opening area during coronary stent implantation immediate by combining high-precision intracavitary imaging techniques with functional studies. Methods Patients who underwent coronary angiography and stent interventional therapy at Beijing Jishuitan Hospital, Capital Medical University from October 22, 2022 to June 1, 2023 were selected. Based on the criterion that the reduction ratio of the postoperative branch opening area measured by endovascular imaging exceeded 50%, the lesions were divided into the postoperative branch opening area reduction group (53 cases) and the postoperative branch opening area normal group (113 cases). The differences in various angiographic features and endovascular imaging indicators of the two groups of lesions were compared, and the virtual coronary flow reserve fraction (Angio-FFR) at each point of the main branch of the bifurcated lesion was measured. The independent risk factors for the reduction of branch opening area were analyzed. The receiver operating characteristic (ROC) curve was established to evaluate the predictive value of intracavitary imaging for the reduction of branch opening area. Results There was no significant difference in coronary angiography data between the two groups (all P>0.05). The proportion of plaque rupture/erosion, healing plaque and calcification in the opening area reduction group were lower than those in the opening area normal group, and the bifurcation angle and the minimum lumen area of the bifurcation nucleus were lower than those in the opening area normal group (all P<0.05). The results  of ROC curve analysis showed that the area under the curve predicted by ΔAngio-FFR for the reduction of branch opening area was 0.80 (P<0.001). The results  of multivariate Logistic regression analysis showed that healing plaque, bifurcation calcification and cross bifurcation ΔAngio-FFR were the risk factors for the reduction of branch opening area (all P<0.05). Conclusion The healing plaque, bifurcation calcification and cross bifurcation ΔAngio-FFR in the bifurcation junction area are the risk factors for the reduction of branch opening area after surgery. ΔAngio-FFR≥0.04 across the bifurcated vascular segment can better predict the reduction of the branch opening area after stent implantation.