血管内超声在左主干病变介入治疗中的临床应用  

The clinical application of Intravascular Ultrasound during Percutaneous Coronary Intervention for Left Main Coronary Disease

作　　者：王博 袁驰 汪和贵 柯永胜 WANG Bo(Department of Cardiology,Tongling People’s Hospital,Tongling 244000,China)

机构地区：[1]铜陵市人民医院心内科,安徽铜陵244000 [2]皖南医学院第一附属医院心内科,安徽芜湖241000

出　　处：《牡丹江医学院学报》2021年第1期38-42,共5页Journal of Mudanjiang Medical University

基　　金：安徽省教育厅自然科学重大项目(KJ2015ZD42)。

摘　　要：目的本研究评估血管内超声(Intravascular ultrasound,IVUS)指导对冠状动脉左主干病变患者经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)临床预后的影响。方法选择皖南医学院第一附属医院2012年1月1日至2016年1月1日间共76例冠状动脉左主干病变并接受PCI治疗的患者。分为两组:IVUS组:29例患者术中使用IVUS指导;造影组:47例患者使用常规造影指导。通过虚拟组织学超声(Virtual histology intravascular ultrasound,VH-IVUS)识别的易损斑块又将IVUS组患者又分为两个亚组:“易损斑块组(12例)”和“非易损斑块组(17例)”。随访的主要终点事件为主要心血管不良事件(Major adverse cardiac events,MACE),包括:心源性死亡、心肌梗死和靶血管血运重建。结果IVUS组患者术后最小支架直径(Minimum stent diameter,MSD)和最小支架横截面积(Minimum stent area,MSA)均大于冠脉造影组患者,有统计学差异[(3.9±0.3)mm vs(3.7±0.3)mm,P=0.004]、[(12.2±2.1)mm2 vs(10.9±1.6)mm2,P=0.003]。IVUS组患者与冠脉造影组相比术后1年的MACE事件发生率有降低趋势(6.9%vs 19.1%,log-rank P=0.072)。易损斑块组和非易损斑块组术后1年的MACE事件发生率相似(8.3%vs 5.9%,log-rank P=0.702)。结论IVUS指导与冠脉造影指导相比有减少左主干病变患者PCI术后1年的MACE事件发生率的趋势,值得临床推广。与非易损斑块组相比,IVUS指导未增加易损斑块组患者PCI术后1年MACE事件的发生风险。Objective To evaluate the clinical impact of the use of intravascular ultrasound(IVUS) during percutaneous coronary intervention(PCI) in patients with left main coronary disease.Methods A total of 76 cases with left main coronary disease who underwent stent implantation from January 1 st,2012 to January 1 st,2016 under the guidance of IVUS(29 cases) or conventional angiography(47 cases) were registered in the First Affiliated Hospital of Wannan Medical College.The IVUS-guided group was divided into two subgroups.The patients(12 cases) who contained vulnerable plaque which was confirmed by Virtual histology intravascular ultrasound(VH-IVUS) were registered in the vulnerable plaque group.The patients(17 cases) who did not contain vulnerable plaque were registered in the non-vulnerable plaque group.The primary endpoint of this study was the rate of one-year the major adverse cardiac events(MACE,including cardiac death,myocardial infarction,and target vessel revascularization).Results The postoperatively minimum stent diameter(MSD) in IVUS group was larger than in angiography group [(3.9±0.3) mm vs(3.7±0.3) mm,P=0.004].The postoperatively minimum stent area(MSA) in IVUS group was larger than in angiography group [(12.2±2.1) mm^2 vs(10.9±1.6) mm^2,P=0.003].There was a tendency of lower risk of one-year the major adverse cardiac events with IVUS guidance compared with angiography guidance(6.9% vs 19.1%,log-rank P=0.072).The one-year MACE rates were similar between the vulnerable plaque group and the non-vulnerable plaque group(8.3% vs 5.9%,log-rank P=0.702).Conclusion Percutaneous coronary intervention with IVUS guidance presented a decreasing tendency of the one-year MACE rate for left main coronary disease when compared with conventional angiography guidance and it was worth clinical promotion.Compared with non-vulnerable plaque group,IVUS guidance did not increase the risk of the one-year MACE in vulnerable plaque group.

关 键 词：血管内超声 冠状动脉左主干病变 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]