Analysis Of Related Factors For Adverse Events In Patients After PCI Guided By Functional Index FFR

Background: Coronary heart disease(CHD)is a series of diseases that cause stenotic lesions of coronary arteries,which in turn cause myocardial ischemia and hypoxia,and can cause chest pain and tightness in varying degrees.For the diagnosis of CHD,the status of coronary angiography(CAG)is no longer necessary,but in critical coronary artery disease and functional ischemic disease,CAG is used to judge the restriction of blood perfusion in the distal myocardium is flawed.Fractional flow reserve(FFR)is to monitor the target vessel with coronary artery stenosis and calculate the ratio of blood pressure at the stenosis to the blood pressure at the opening of the diseased vessel.Several studies have also proved that FFR has a positive effect on critical lesions.It can help us judge the coronary arteries are reversible stenosis from a functional perspective.CAG combined with FFR-guided percutaneous coronary intervention(PCI)can effectively reduce the proportion of major adverse cardiac events(MACE)in patients with coronary heart disease and improve the quality of life of patients.However,there are few studies on the potential related factors of MACE,the predictive value of related factors and the level of post-PCI FFR should be improved to better protect patients.Objective: To explore the potential probable related factors and related risk factors that influence the prognosis of patients with moderate coronary stenosis undergoing CAG combined with FFR-guided PCI in predicting the occurrence of MACE.Methods: A retrospective analysis was performed for the clinical data of 210 patients with coronary heart disease who underwent CAG in our hospital from January 2017 to February 2019 and were found to have moderate stenosis of at least one branch of the coronary artery,among whom 121 patients underwent PCI under the guidance of FFR,9patients did not complete post-PCI FFR measurement,and the remaining 112 patients were followed up for at least 12 months.The follow-up methods include telephone follow-up and outpatient follow-up,Inpatient follow-up,of 8 patients were lost to follow-up,finally 104 patients were included in the study,according to the presence or absence of MACE during the follow-up period(defined as typical angina pectoris,recurrent myocardial infarction,and death),the patients were divided into MACE group and no-MACE group.A univariate analysis was used to compare the baseline data,and PCI data between the two groups,a multivariate binary Logistic regression analysis was used to analyze the relevant factors for MACE in patients.ROC curve was used to analyze the value of post-PCI FFR of target vessel in predicting MACE,and the most appropriate cut-off value for the patient.according to the cut-off value,it is divided into two groups to further verify the related factors of MACE.Results : All 104 patients who underwent CAG combined with FFR for PCI were followed up for at least 12 months,and 14 of them had MACE(10 patients with typical angina pectoris,4 with myocardial infarction,and 0 patinents with death.Coronary angiography determine whether it was a target vascular lesion).The univariate analysis that the proportion of men in the two groups,age,smoking history,diabetes history,history of hypertension,history of statin administration,ACEI and ARB administration,oral history of aspirin,creatinine value,low-density lipoprotein value,left ventricular ejection fraction,SYNTAX score,and target vessels(anterior descending branch,circumflex branch,right coronary artery),number of lesions(1 lesion,2 lesions,3lesions),preoperative stenosis,and no significant difference(P>0.05),and the pre-PCI FFR(0.744±0.052 VS 0.703±0.092),red blood cell distribution width(13.97±2.19 VS15.14±1.26),post-PCI FFR(0.915±0.033 VS 0.876±0.030),all the above variables were statistically significant(P<0.05).The results of binary Logistic regression analysis showed that the increase of post-FFR level(OR=0.700,P=0.001,95%CI=0.566~0.866)was a relevant factor for MACE.The ROC curve shows that the most appropriate cut-off value for the occurrence of MACE is FFR = 0.905,the specificity is 86.0%,and the sensitivity is 64.4%.The post-PCI FFR can predict the occurrence of MACE to a certain extent(AUC=0.805,95 % CI=0.697~0.912,P<0.01),according to the post-PCI FFR cutoff value,it was re-divided into two groups.Single factor analysis showed that there was a significant difference in the occurrence of MACE between the two groups of patients(P <0.01).Conclusions:For patients with CHD combined with FFR to guide PCI,pre-PCI FFR and red blood cell distribution width may be relevant risk factors for patients with MACE,the post-PCI FFR is a protective factor for MACE in patients,and its value can predict the occurrence of MACE.The post-PCI FFR should be ? 0.905 as much as possible to reduce the possibility of MACE in patients.