支架影像增强显影技术对老年ST段抬高型心肌梗死患者支架膨胀不良的指导作用  

Effect of stent boost subtract imaging technique on stent underexpansion in elderly STEMI patients

作　　者：张蛟 段媛媛[2] 俞泓 荆丽敏 李屹 贾小伟 金德奎 刘惠亮[4] Zhang Jiao;Duan Yuanyuan;Yu Hong;Jing Limin;Li Yi;Jia Xiaowei;Jin Dekui;Liu Huiliang(Department of Cardiology,Beijing Electric Power Hospital of State Grid Company,Beijing 100073,China)

机构地区：[1]国家电网公司北京电力医院心内科,100073 [2]解放军总医院第二医学中心保健三科 [3]解放军总医院第三医学中心心内科 [4]解放军总医院第三医学中心心脏病研究所

出　　处：《中华老年心脑血管病杂志》2022年第2期132-135,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：北京市科技计划项目(Z161100000516091)。

摘　　要：目的应用光学相干断层成像(OCT)来评价支架影像增强显影(SBS)和冠状动脉造影(CAG)指导老年急性ST段抬高型心肌梗死(STEMI)患者PCI时对支架膨胀不良的影响。方法连续入选2015年6月~2019年3月解放军总医院第三医学中心心内科行药物洗脱支架置入的老年STEMI患者126例,按照是否采用SBS指导PCI分为SBS组63例和CAG组63例,以OCT为金标准,评价规范SBS技术对STEMI患者药物洗脱支架置入后支架膨胀不良的影响。结果 SBS和OCT共纳入194个病变图像,SBS判断支架膨胀不良47个(24.2%),OCT判断支架膨胀不良50个(25.8%),两者Kappa=0.789(P<0.01)。SBS判断支架膨胀不良的敏感性80%,特异性96%,阳性预测值88%,阴性预测值93%。SBS组主要不良心血管事件发生率明显低于CAG组,差异有统计学意义(3.2%vs 14.8%,P<0.05)。结论与血管内超声和OCT比较,SBS是一种快速的支架成像处理技术,可以准确地量化支架的扩张程度,既省时又经济,从而帮助更多的临床医师优化PCI策略,以期改善患者长期预后。Objective To evaluate the harmfull effect of SBS imaging technique and CAG on stent OCT.Methods One the underexpansion in elderly STEMI patients during PCI according to DES hunimaging technique dred and twenty-six elderly STEMI patients who underwent were divided into SBS imaging group(n=63)and group(n=63)according CAG technique was to whether SBS used to guide PCI.The harmfull effect of standardized SBS imaging technicque on stent unas derexpansion in elderly STEMI patients after DES implantation was assessed with OCT its standard.Results A gold total of194lesions were included in SBS and OCT image analysis.SBS patients (24.2%)with47identified stent underexpansion while OCT identified50patients96%,a of Kappa=0.789(P<0.01).SBS(25.8%),both positive80%,a of has a sensitivity specificity for88%,and of predictive value a negative predictive value of93%identifying stent underexpansion.The incidence of major adverse cardiovascular events in SBS group was significantly vs group,and CAG significant(3.2%14.8%,technique lower than that in the difference was statistically rapid P<0.05).Conclusion SBS imaging technique is a is stent imaging processing and that can can accurately quantify the stent expansion and both time-saving and economical.It the thus help more clinicians to optimize the PCI strategies for to improve ultrasonography long-term outcome of elderly STEMI patients as compared with endovascular and OCT.

关 键 词：体层摄影术 光学相干 支架 冠状血管造影术 ST段抬高型心肌梗死 药物洗脱支架 

分 类 号：R542.22[医药卫生—心血管疾病]