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作 者:李小波[1] 高晓飞[1] 邵明学[1] 田乃亮[1] LI Xiaobo;GAO Xiaofei;SHAO Mingxue;TIAN Nailiang(Department of Cardiology,Nanjing First Hospital,Nanjing Medical University,Nanjing,210000,China)
机构地区:[1]南京医科大学附属南京医院心内科,南京210000
出 处:《临床心血管病杂志》2020年第7期604-607,共4页Journal of Clinical Cardiology
基 金:江苏省卫健委面上项目(No:2017-45);南京市卫健委重点课题(No:ZKX16051)。
摘 要:目的:探讨血管内超声(IVUS)引导药物洗脱支架(DES)植入治疗慢性完全闭塞性病变(CTO)的远期疗效。方法:将230例成功开通CTO病变的患者按1∶1随机分组为IVUS引导组和冠状动脉造影(CAG)引导组。主要研究终点为术后5年时主要不良心血管事件(MACE),包括全因死亡、心肌梗死、靶血管血运重建(TVR)和支架内血栓(ST)。结果:230例患者中,219例成功完成5年临床随访,其中IVUS引导组109例,CAG引导组110例。2组间临床特征和CAG特征没有统计学差异。219例患者术后5年时共发生88例MACE(40.18%),其中IVUS引导组38例(34.9%),略低于CAG引导组的50例(45.5%),但没有统计学差异(P=0.110)。2组间全因死亡、心源性死亡、心肌梗死、TVR、靶病变血运重建(TLR)没有统计学差异。IVUS引导组ST发生率为1.8%,CAG引导组为8.2%,有显著统计学差异(P=0.032)。结论:对于CTO病变,相比于CAG引导,IVUS引导DES植入可以降低远期ST风险,也有降低MACE的趋势。Objective:To explore the long-term clinical outcomes of intravascular ultrasound(IVUS)guided drug-eluting stent(DES)implantation for chronic total occlusion(CTO).Method:A total of 230 CTO patients were prospectively enrolled and randomized in 1:1 fashion to the IVUS guided group and the coronary angiography(CAG)guided group.The primary endpoint was major adverse cardiovascular events(MACE)5 years after surgery,including all cause death,myocardial infarction,target vessel revascularization(TVR)and stent thrombosis(ST).Result:Five-year clinical follow-up was available in 219 CTO patients,with 109 patients in the IVUS guided group and 110 patients in the CAG guided group.The clinical and angiographic characteristics between two groups had not statistical difference.After 5 years of operation,MACE occurred in 88 patients(40.18%),with 38(34.9%)in the IVUS guided group and 50(45.5%)in the CAG guided group(P=0.110).There was no difference in all cause death,cardiac death,myocardial infarction,TVR,and target lesion revascularization(TLR)between two groups.The incidence rate of ST in the IVUS guided group was 1.8%,which was significantly lower than 8.2%in CAG guided group(P=0.032).Conclusion:IVUS guided DES implantation could reduce the risk of long term stent thrombosis compared with the angiography guided in CTO patients.
关 键 词:血管内超声 冠状动脉造影 药物洗脱支架 慢性完全闭塞性病变
分 类 号:R541.4[医药卫生—心血管疾病]
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