靶病变浅表性钙化对经皮冠状动脉介入治疗的影响

Impact of superficial calcification of coronary target lesions on outcomes of percutaneous coronary intervention

摘要:

目的 探讨冠状动脉靶病变浅表性钙化对介入操作及疗效的影响。方法 连续收集61例冠心病患者（61处靶病变），根据血管内超声（IVUS）检测冠脉靶病变钙化情况分为浅表性钙化组和非浅表性钙化组，对比两组之间介入操作特点、经皮冠脉介入治疗（PCI）术后临床及影像学特征。结果 浅表性钙化29例，非浅表性钙化32例。浅表性钙化组面积狭窄率大于非浅表性钙化组[（75.70±7.11）% vs （68.78±5.56）%，P＝0.019]；前者术后支架对称性及支架膨胀指数明显小于后者[（0.85±0.06） vs （0.90±0.02），P＝0.016；（0.68±0.14） vs （0.82±0.10），P＝0.021]。浅表性钙化组术后最小支架直径[（2.51±0.43） vs （2.76±0.29）mm]、最小支架面积[（5.86±1.82） vs （6.73±1.40）mm2]、相对管腔获得[（1.26±0.68） vs （1.37±0.72）]趋于小于非浅表性钙化组，但差异未发现统计学意义。两组术中术后并发症差异无统计学意义。所有患者无院内主要不良心脏事件发生。结论 冠状动脉靶病变浅表性钙化可能较非浅表性钙化对支架的充分扩张及对称性影响更大。

Abstract:

Objective To investigate the impact of superficial calcification of coronary target lesions on the procedures and outcomes of percutaneous coronary intervention (PCI). Methods A total of 61 consecutive patients with 61 target lesions who underwent intravascular ultrasound (IVUS) to determine the characteristics of lesions before PCI and stent implantation in our department from May to December 2012 were enrolled in this study. According to the results of IVUS, these lesions were divided into 2 groups, superficial calcified group and non-superficial calcified group. The intervention procedures, clinic and imaging features after PCI were compared between the two groups. Results There were 29 lesions in superficial calcified group and 32 in non-superficial calcified group. The stenosis area was higher in superficial calcified group than in the control group [(75.70±7.11)% vs (68.78±5.56)%, P＝0.019]. The postoperative stent symmetry and expansion were significantly lower in the superficial calcified group than in non-superficial calcified group [(0.85±0.06) vs (0.90±0.02), P＝0.016; (0.68±0.14) vs (0.82±0.10), P＝0.021, respectively]. The minimus stent diameter [(2.51±0.43) vs (2.76±0.29)mm], minimum stent area [(5.86±1.82) vs (6.73±1.40)mm2) and relative lumen gain (1.26±0.68) vs (1.37±0.72)] were also tended to be smaller in superficial calcified group than in the non-superficial calcified group, though without significant difference. There was no difference in the procedural complications incidence. No major adverse cardiac event was seen in this cohort of patients. Conclusion Compared with non-superficial calcification of coronary target lesions, the superficial calcification may interfere the appropriate stent symmetry and optimal stent expansion.