血管内超声指导介入治疗非ST段抬高型急性冠状动脉综合征患者冠状动脉分叉及开口病变的效果及预后

摘要

目的 探讨血管内超声(IVUS)指导介入治疗对非ST段抬高型急性冠状动脉综合征患者冠状动脉分叉及开口病变的效果及对远期预后的影响.方法 选取2014年4月至2015年4月在首都医科大学附属北京安贞医院行冠状动脉造影(CAG)明确诊断为冠状动脉分叉及开口病变的患者106例,均行经皮冠状动脉介入(PCI)治疗,将患者根据随机数字表法分为IVUS组(52例)及CAG组(54例).IVUS组患者于PCI术前、术后行IVUS评估,指导手术方式及支架选择,CAG组仅根据CAG结果选择手术方式及支架.比较2组患者冠状动脉病变特征、介入治疗情况(置入支架个数、长度、直径),并记录术后12个月主要不良心血管事件(MACE,包括心源性死亡、靶血管血运重建、非致死性心肌梗死)发生情况.结果 2组患者冠状动脉病变部位、病变血管支数、置入支架个数、置入支架长度比较,差异均无统计学意义(均P＞0.05).IVUS组置入支架直径大于CAG组[(3.14 ±0.42) mm比(2.87 ±0.29) mm],差异有统计学意义(P＜0.05).IVUS组患者术后12个月发生MACE 1例(1.9％,为靶血管血运重建);CAG组发生MACE 3例(5.6％,靶血管血运重建2例,非致死性心肌梗死1例).结论 在非ST段抬高型急性冠状动脉综合征患者中,IVUS指导PCI治疗冠状动脉分叉及开口病变,有助于优化支架置入,改善PCI远期预后.%Objective To investigate the effect and long-outcomes of intravenous ultrasound (IVUS)-guided interventional therapy on coronary bifurcation and ostial lesions in patients with non-ST-segment elevation acute coronary syndrome.Methods A total of 106 patients with coronary bifurcation or ostial lesions who were diagnosed by coronary angiography (CAG) and undergoing percutaneous coronary intervention (PCI) in Beijing Anzhen Hospital,Capital Medical University from April 2014 to April 2015 were randomly divided into IVUS group (52 cases) and CAG group(54 cases).Patients in IVUS group had IVUS examination before and after PCI,and interventional procedures and coronary stent selection were based on information provided by IVUS.Patients in CAG group were performed PCI based on CAG results.Characteristics of coronary lesion,number,length and diameter of stent and occurrence of postoperative 12 months major adverse cardiovascular events(MACE,including cardiac death,target vessel revascularization and nonfatal myocardial infarction) were analyzed.Results There were no significant differences of coronary lesion site,number of diseased vessel,number and length of stent between groups (P ＞ 0.05).Diameter of stent in IVUS group was significantly longer than that in CAG group [(3.14 ± 0.42) mm vs (2.87 ± 0.29) mm] (P ＜ 0.05).One case of MACE (1.9％,target vessel revascularization) occurred in IVUS group,and 3 cases of MACE (5.6％,2 cases of target vessel revascularization and 1 case of nonfatal myocardial infarction) occurred in CAG group during 12 months after PCI.Conclusion IVUS-guided PCI can help optimize stent placement and improve long-term prognosis in treating coronary bifurcation and ostial lesions in patients with non-ST-segment elevation acute coronary syndrome.