光学相干断层成像对ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗策略的影响  

Impact of optical coherence tomography guided primary percutaneous coronary intervention on physician decision-making

作　　者：许敏[1] 郭金成[1] 徐荣[1] 王国忠[1] 柳子静[1] 牛丹[1] 高国旺[1] 

机构地区：[1]首都医科大学附属北京潞河医院心内科,北京101149

出　　处：《中国介入心脏病学杂志》2017年第8期432-436,共5页Chinese Journal of Interventional Cardiology

基　　金：通州区科技计划精准医疗项目(KJ2016CX037-03)

摘　　要：目的探讨光学相干断层成像(OCT)指导下对急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)策略的影响。方法纳入2016年1月至2017年5月接受急诊PCI并行OCT检查的STEMI患者100例,利用OCT检查明确STEMI发病机制,评价PCI即刻效果,随访12个月观察预后。结果 17例(17.0%)患者因OCT图像欠清晰未能明确心肌梗死发病机制,其中15例置入支架;其余83例患者中斑块破裂54例(65.1%,54/83)、斑块侵蚀22例(26.5%,22/83)、钙化结节2例(2.4%,2/83)、支架贴壁不良致晚期支架内血栓形成2例(2.4%,2/83)、亚急性支架内血栓形成1例(1.2%,1/83)、冠状动脉痉挛2例(2.4%,2/83),其中68例置入支架。83例置入支架、造影成功的患者中,OCT发现支架术后造影不易识别的支架贴壁不良、组织脱垂、支架膨胀不全患者18例(21.7%,18/83);支架边缘夹层16例(19.3%,16/83),其中血流受限需要干预的支架近端夹层2例(2.4%,2/83)。17例未置入支架患者中冠状动脉痉挛2例、血栓负荷重1例,其余14例(斑块破裂7例、斑块侵蚀4例、晚期支架内血栓形成2例及亚急性支架内血栓形成1例)因OCT检查残余狭窄<70%、TIMI血流Ⅲ级未置入支架。随访(11.0±4.0)个月,除1例院内死于心源性休克和1例亚急性支架内血栓形成患者外,所有出院患者均未发生主要不良心血管事件。结论 OCT可以检测出约1/4 STEMI患者冠状动脉支架置入术后多种不良特征并进行治疗。Objective To investigate the impact of optical coherence tomography（OCT） imaging on physician decision-making during primary percutaneous coronary intervention（PCI） in patients with ST-segment elevation myocardial infarction （STEMI）. Methods From January 2016 to May 2017, OCT was performed in 100 cases pre- and post- primary PCI. The pathogenesis of myocardial infarction was determined and immediate effect of PCI evaluated by OCT. Clinical outcome during a 12-months follow up was analyzed. Results The data from 17 patients were excluded for further study due to poor OCT images quality. The rates of plaque rupture, plaque erosion, calcification nodules, stent malapposition and coronary spasm were 65.1%（54/83）, 26.5%（22/83）, 3.6%（3/83）, 2.4%（2/83） respectively among the remaining 83 patients with sufficient OCT quality images. of the overall rate of stent malposition, tissue prolapse and incomplete stent expansion was 21.7%（18/83）. The incidence of edge dissection was 19.3%（16/83）, and among them 2 patients required treatment with stent implantation. Among the 17 patients without stenting：coronary spasm were found in 2 cases, thrombus overload in 1 case after thrombus aspiration, plaque rupture in 7 cases , plaque erosion in 4 cases and stent malposition in 3 cases. One patient died in hospital for cardiogenic shock and one patient had subacute stent thrombosis . There were no major adverse cardiac events occurred in the remaining patients during the （11.0±4.0） months of follow-up. Conclusions OCT can identify nonoptimal stent deployment in approximately one-fourth of STEMI patients undergoing primary PCI, thus providing preliminary guidance to the physician for further mangement.

关 键 词：心肌梗死 光学相干断层成像 经皮冠状动脉介入治疗 

分 类 号：R542.22[医药卫生—心血管疾病]