血管内超声与单纯冠状动脉造影指导下无保护左主干病变介入治疗的疗效对比研究  

Outcome Comparison of Percutaneous Coronary Intervention Guided by Intravascular Ultrasound or Angiography for Unprotected Left Main Disease

作　　者：刘圣文[1] 胡奉环[1] 陈珏[1] 窦克非[1] 吴永健[1] 杨伟宪[1] 杨跃进[1] 徐波[2] 陈纪林[1] 乔树宾[1] LIU Shengwen;HU Fenghuan;CHEN Jue;DOU Kefei;WU Yongjian;YANG Weixian;YANG Yuejin;XU Bo;CHEN Jilin;QIAO Shubin(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病中心,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院心导管实验室,北京市100037

出　　处：《中国循环杂志》2021年第9期841-845,共5页Chinese Circulation Journal

基　　金：中国医学科学院医学与健康科技创新工程(2016-I2M-1-009)。

摘　　要：目的:比较血管内超声(IVUS)和单纯冠状动脉造影指导的无保护左主干冠状动脉疾病(ULMCAD)介入治疗的疗效。方法:回顾性纳入本院2004年1月至2015年12月行ULMCAD介入治疗的患者3960例,其中1568例(39.6%)在IVUS指导下完成左主干支架置入术(IVUS组),其余2392例(60.4%)仅在冠状动脉造影指导下行介入治疗(对照组)。比较两组3年随访时的主要不良心脏事件(MACE,包括全因死亡、心肌梗死和再次血运重建)及其各组分的发生率。结果:与对照组相比,IVUS组除男性比例较高(77.7%vs.80.5%,P=0.03)外,其他基线临床资料相似。IVUS组的最终球囊对吻扩张率、后扩张率、双支架术应用率和操作成功率较对照组更高,置入支架的平均直径更大[(3.6±0.5)mm vs.(3.4±0.5)mm,P<0.01]。IVUS组的MACE(12.2%vs.15.9%,P<0.01)、全因死亡(2.8%vs.4.3%,P=0.02)、心肌梗死(3.2%vs.5.3%,P<0.01)、再次血运重建(7.8%vs.9.7%,P=0.04)和确定或可能的支架内血栓形成(1.0%vs.1.9%,P=0.02)发生率较对照组更低,而两组的靶血管血运重建率(3.5%vs.4.3%,P=0.21)和靶病变血运重建率(2.7%vs.3.5%,P=0.20)差异均无统计学意义。结论:与单纯冠状动脉造影指导相比,IVUS指导下的ULMCAD介入治疗疗效更佳、更安全。Objectives:To compare the outcomes of percutaneous coronary intervention(PCI)guided by intravascular ultrasound(IVUS)or angiography in unprotected left main coronary artery disease(ULMCAD).Methods:From January 2004 to December 2015,ULMCAD PCI was performed in 3960 patients at our institution,1568(39.6%)cases were performed under IVUS guidance(IVUS group),2392(60.4%)cases were performed only under angiography guidance(control group).Patients received 3-years follow-up.The clinical outcome included the incidence of major adverse cardiac events(MACE,included all-cause death,myocardial infarction,and repeated revascularization),allcause death,myocardial infarction,repeated revascularization.Results:There were significantly higher proportion of male patients in IVUS group than the control group(80.5%vs.77.7%,P=0.03),other clinical features were similar between the two groups.In procedural details,rates of two stent strategy in left main bifurcated lesion,final kissing balloon,post-dilation,and procedural success were significantly higher in IVUS group than in the control group.Stent diameters were significantly larger in IVUS group than in the control group([3.6±0.5]mm vs.[3.4±0.5]mm,P<0.01).Rates of MACE(12.2%vs.15.9%,P<0.01),all-cause death(2.8%vs.4.3%,P=0.02),myocardial infarction(3.2%vs.5.3%,P<0.01),revascularization(7.8%vs.9.7%,P=0.04)and definite or probable stent thrombosis(1.0%vs.1.9%,P=0.02)were significantly lower in IVUS group than in the control group.Target vessel revascularization rate(3.5%vs.4.3%,P=0.21)and target lesion revascularization rate(2.7%vs.3.5%,P=0.20)were similar between the two groups.Conclusions:Compared to angiography guidance,IVUS guidance in ULMCAD PCI is more safe and associated with superior outcomes.

关 键 词：血管内超声 冠状动脉造影 左主干病变 经皮冠状动脉介入治疗 

分 类 号：R54[医药卫生—心血管疾病]