血管内超声指导经皮冠状动脉介入治疗对非ST段抬高型急性冠脉综合征临界病变患者预后的影响

Prognostic impact of interventional therapy guided by intravascular ultrasound in non-ST segment elevation acute coronary syndrome patients with intermediate lesions

摘要:

目的 观察血管内超声(IVUS)指导经皮冠状动脉介入(PCI)治疗对非ST段抬高型急性冠脉综合征(NSTE-ACS)临界病变患者临床预后的影响。方法 入选2016年6月至2017年1月陕西省第四人民医院心血管内科冠状动脉造影(CAG)提示可行PCI术的NSTE-ACS临界病变患者100例,随机数字表法分为IVUS组和血流储备分数(FFR)组各50例,术后随访12个月,比较2组患者主要不良心血管事件(MACEs)发生情况。结果 IVUS组和FFR组患者病变血管直径[(3.5±0.7) vs(3.0±0.5)mm]、狭窄程度[(62.6±5.0)% vs(57.2±7.5)%]、病变长度[(20.2±8.8) vs(23.5±10.7)mm]、PCI相关并发症发生率[8.0%(4/50) vs 4.0%(2/50)]等差异无统计学意义(P＞0.05)；相比FFR组患者,IVUS组患者支架植入率较高[56.0%(28/50) vs 38.0%(19/50)],但差异无统计学意义(P＞0.05)。术后随访 12个月MACEs发生率差异无统计学意义[18.8%(9/48) vs 14.3%(7/49),P=0.55]。结论 对于NSTE-ACS临界病变患者,IVUS指导血运重建治疗的短期临床预后不劣于FFR指导。

Abstract:

Objective To determine the effect of percutaneous coronary intervention (PCI) guided by intravascular ultrasound (IVUS) on the prognosis of non-ST segment elevation acute coronary syndrome (NSTE-ACS) patients with intermediate lesions. Methods A total of 100 NSTE-ACS with intermediate lesions patients allowing elective PCI indicated by coronary angiography (CAG) in our department from June 2016 to January 2017 were recruited in this study. They were randomly divided into IVUS group and fractional flow reserve (FFR) group, with 50 cases in each group. All patients were followed up for 12 months, and the incidence of major adverse cardiovascular events (MACEs) was compared between the 2 groups. Results There were no significant differences in the diameter of lesion vessel [(3.5±0.7) vs (3.0±0.5)mm], degree of stenosis [(62.6±5.0)% vs (57.2±7.5)%], lesion length [(20.2±8.8) vs (23.5±10.7)mm], and the incidence rates of PCI-related complications [8.0%(4/50) vs 4.0%(2/50)] between the IVUS group and FFR group (P>0.05). The stent implantation rate was higher in the IVUS group than the FFR group [56.0%(28/50) vs 38.0%(19/50)], though without statistical difference (P>0.05). There was no significant difference in the incidence of MACEs in 12 months after surgery between the 2 groups [18.8%(9/48) vs 14.3%(7/49), P=0.55]. ConclusionFor the NSTE-ACS patients with intermediate lesions, IVUS is not inferior to FFR in the guidance of revascularization therapy for the short-term prognosis.