血管内超声指导冠状动脉支架内再狭窄行PCI的临床价值分析  

Analysis of clinical value of PCI guided by intravascular ultrasound in coronary intra-stent restenosis

作　　者：刘永昌 王树鹏 LIU Yong-chang;WANG Shu-peng(Cardiology Department,Chifeng Municipal Hospital,Chifeng 024000,China)

机构地区：[1]内蒙古赤峰市医院心内科,024000

出　　处：《中国实用医药》2023年第22期6-11,共6页China Practical Medicine

摘　　要：目的探讨血管内超声(IVUS)及冠状动脉造影(CAG)指导冠状动脉支架内再狭窄(ISR)行经皮冠状动脉介入治疗(PCI)的临床价值,并分析远期不良事件发生的影响因素。方法94例药物洗脱支架(DES)置入术后ISR行PCI的患者为研究对象,随机分为IVUS组(实施IVUS指导)及CAG组(实施CAG指导),每组47例。收集并比较两组患者的临床基础资料及基础CAG特征;对患者进行电话或门诊随访,以主要终点事件及次要终点事件为研究终点,比较两组患者远期预后;采用COX风险比例模型分析冠状动脉ISR患者远期主要终点事件的影响因素。结果两组患者的人口学资料(男性、年龄、体质量指数)、心血管危险因素(高血压、糖尿病、高脂血症、冠心病家族史、吸烟史)、辅助检查[左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)、低密度脂蛋白胆固醇(LDL-C)、N末端B型利钠肽原(NT-proBNP)、血肌酐、血尿酸]、临床表现[急性ST段抬高型心肌梗死(STEMI)、急性非ST段抬高型心肌梗死(NSTEMI)、不稳定型心绞痛(UAP)、稳定型心绞痛(SAP)]、药物治疗(阿司匹林、P2Y12受体抑制剂、他汀类)对比,差异无统计学意义(P>0.05)。两组患者基础的病变位置、冠状动脉ISR分型、特殊病变、参考血管直径、靶病变长度、直径狭窄率对比,差异无统计学意义(P>0.05)。随访期间,IVUS组失访7例,CAG组失访3例。IVUS组主要终点事件发生率为5.00%、靶血管血运重建发生率为2.50%、再次入院率为25.00%,均低于CAG组的20.45%、15.91%、47.73%,差异具有统计学意义(P<0.05);两组患者的心源性死亡、心肌梗死、卒中、次要终点事件、再发心绞痛、支架内血栓、出血发生率对比,差异无统计学意义(P>0.05)。COX风险比例模型分析显示:年龄、性别、高血压、糖尿病、高脂血症对冠状动脉ISR患者远期主要终点事件的发生无独立预测价值,IVUS是冠状动脉ISR患者远期主要�Objective To discuss the clinical value of intravascular ultrasound(IVUS)and coronary angiography(CAG)guiding percutaneous coronary intervention(PCI)for coronaryintra-stent restenosis(ISR),and analyze the influencing factors of long-term adverse events.Methods A total of 94 patients undergoing PCI for coronary ISR after drug eluting stent(DES)implantation were studied and randomly divided into IVUS group(receiving IVUS guidance)and CAG group(receiving CAG guidance),with 47 cases in each group.Clinical basic data and basic CAG characteristics of the two groups were collected and compared.The patients were followed up by telephone or outpatient,and the primary and secondary endpoint events were used as the study endpoints to compare the long-term prognosis between the two groups.The factors influencing long-term primary endpoint events in patients with coronary ISR were analyzed by Cox proportional hazard model.Results The demographic data(male,age,body mass index),cardiovascular risk factors(hypertension,diabetes,hyperlipidemia,family history of coronary heart disease,smoking history),auxiliary examination[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),low density lipoprotein cholesterol(LDL-C),N-terminal pro-B-type natriuretic peptide(NT-proBNP),serum creatinine,serum uric acid],clinical manifestations[acute ST-elevation myocardial infarction(STEMI),acute non-ST-elevation myocardial infarction(NSTEMI),unstable angina pectoris(UAP),stable angina pectoris(SAP)],drug therapy(aspirin,P2Y12 receptor inhibitors,statins)of the two groups were compared,and the differences were not statistically significant(P>0.05).There was no statistically significant difference in terms of the basic lesion location,coronary artery ISR classification,special lesion,reference vessel diameter,target lesion length and diameter stenosis rate between the two groups(P>0.05).During the follow-up period,7 cases were lost in the IVUS group and 3 cases in the CAG group.The incidence of primary endpoint eve

关 键 词：血管内超声 冠状动脉造影 冠状动脉支架内再狭窄 经皮冠状动脉介入治疗 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.4[医药卫生—诊断学]