Prognostički značaj koronarne rezerve protoka u stratifikaciji rizika pacijenata sa hroničnom totalnom okluzijom desne koronarne arterije i intermedijarnom stenozom leve koronarne arterije
Abstract
Uvod: Koronarna rezerva protoka (CFR) predstavlja klinički korisnu, neinvazivnu dijagnostičku metodu za procenu funkcionalne sposobnosti koronarnih arterija i značajna je u njihovom dugoročnom praćenju kod pacijenata. Međutim CFR jos uvek nije dovoljno
istražena u prethodnim studijama.
Cilj: Ispitivanje prognostičkog značaja koronarne rezerve protoka u stratifikaciji rizika pacijenata sa hroničnom totalnom okluzijom desne koronarne arterije i intermedijarnom stenozom leve koronarne arterije
Materijal i metode: 71 pacijent, prosečne starosti 64 ± 7 godina, (84,5%) muškog pola, sa stenozom leve descedentne koronarne arterije (LAD), promera 50-70%, i sa hroničnom totalnom okluzijom desne koronarne arterije, upućeni su na neinvazivnu procenu funkcionalnog značaja stenoze LAD. Transtorakalna Dopler ehokardiografija je korišćena za dobijanje brzine koronarnog protoka (CFR). Pacijenti su praćeni tokom prosečnog perioda od
21 (18-24) meseci za pojavu neželjenih događaja, uključujući kardiovaskularnu smrt, infarkt miokarda, baypass operaciju i perkutanu koronarnu intervenciju.
Rezultati: Tokom perioda praćenja bilo je ukupno 23 neželjena događaja (4 smrtna ishoda, 2 infarkta miokarda, 7 bypass operacija i 10 PKI). Pacijenti sa CFR<2 su imali značajno više neželjenih događaja (n=9; 56,3% vs n=14; 25,5%; p=0,021), bili su značajno stariji (CFR<2 68±9 vs CFR>2 62±6; p=0,011), sa većom učestalošću pozitivne porodične anamneze
(CFR<2 14; 87,5% vs CFR>2 26; 47,3%; p=0,039), kao i značajno većom učestalošću
trosudovne koronarne bolesti (CFR<2 14; 87,5% vs CFR>2 30; 54,5%; p=0,017). Koristeći
Kaplan-Meier-ovu krivu dobili smo da pacijenti sa CFR<2 imaju značajno kraći prosečni period bez neželjenih događaja (15,4 ± 2,8 meseci vs 23,5 ± 1,1 mesec, Log Rank 7,407, p=0,008). Nezavisni prediktor neželjenih događaja bio je CFR<2 (p=0,012, B=-0,180 HR 0,340; 95% CI 0,146 – 0,788).
Zaključak: CFR ima važnu ulogu u stratifikaciji rizika pacijenata sa hroničnom totalnom okluzijom desne koronarne arterije i intermedijarnom stenozom leve koronarne arterije
Ključne reči: CFR, koronarna arterija, okluzija, stenoza
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