在复杂的分叉病变中PCI的OCT或血管学指南
Niels R Holm1, Lene N Andreasen1, Omeed Neghabat1
1From the Department of Cardiology, Aarhus University Hospital, Aarhus (N.R.H., L.N.A., O.N., S.-H.B.R., L.J.H.M., M.S.L., E.H.C.), the Department of Cardiology, Gentofte Hospital, Gentofte (N.T.O., A.T.K.), the Department of Cardiology, Zealand University Hospital, Roskilde (O.H.), the Department of Cardiology, Rigshospitalet, Copenhagen (J.L.), the Department of Cardiology, Odense University Hospital, Odense (L.O.J.), and the Department of Cardiology, Aalborg University Hospital, Aalborg (A.E.) - all in Denmark; the Department of Cardiology, North Estonia Medical Center, Tallinn, Estonia (P.L.); Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (I.K.); the Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven (J.B.), and the Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (J.D.) - both in Belgium; the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg (J.O.), the Department of Cardiology, Karolinska University Hospital (L.H.), and the Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset (N.W., I.S.-P.), Stockholm, and the Department of Cardiology, Örebro University Hospital, Örebro (F.C.) - all in Sweden; the Department of Cardiology, Oslo University Hospital, Ullevål (P.H.), the Department of Cardiology, Trondheim University Hospital, Trondheim (M.H.), the Department of Cardiology, Oslo University Hospital, Oslo (C.E.), and the Department of Cardiology, Sørlandet Sykehus Arendal, Arendal (S. Calic) - all in Norway; the Department of Cardiology, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester (S. Chowdhary), the Department of Cardiology, Royal Bournemouth Hospital, Bournemouth (P.O.), the Department of Cardiology, Golden Jubilee Hospital, Glasgow (S.W.), the Department of Cardiology, Sussex Cardiac Centre, Brighton (J.C.), the Department of Cardiology, Belfast Health and Social Care Trust, Belfast (A.M.), and Cardiology Care Group, St. George's University Hospitals NHS Foundation Trust and Cardiovascular Clinical Academic Group, St. George's University of London, London (J.C.S.) - all in the United Kingdom; the Department of Cardiology, St. Antonius Ziekenhaus, Nieuwegein (J.P.V.K.), the Department of Cardiology, Amsterdam UMC, Amsterdam (P.K.), and the Department of Cardiology, Northwest Hospital Alkmaar, Alkmaar (T.H.) - all in the Netherlands; Azienda Ospedaliero-Universitaria di Ferrara, Cardiology Unit, Ferrara (S.B.), and the Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome (F.B.) - both in Italy; the Department of Cardiology, University Hospital Galway, Galway, Ireland (D.M.); 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (L.K.); Tampere Heart Hospital, Tampere University Hospital, Tampere, Finland (O.A.K.); and Vivantes Klinikum im Friedrichshain, Berlin (S.K.).
视觉连贯断层扫描 (OCT) 引导的穿皮冠状动脉干预 (PCI) 与标准血管学指导相比,在复杂的冠状动脉分支病变中显著减少了主要的不良心脏事件.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 医疗成像医学成像
背景情况:
- 通过成像指导的皮肤冠状动脉干预 (PCI),特别是光学连贯性断层扫描 (OCT),可能比传统血管学提供更好的结果.
- 与血管学引导的PCI相比,对于复杂的冠状动脉分支病变的常规OCT指导的好处仍然不确定.
研究的目的:
- 评估复杂的冠状动脉分支病变PCI中的常规OCT指导是否与血管学指导的PCI相比改善了临床结果.
主要方法:
- 一个多中心,随机,开放的标签试验,涉及38个欧洲中心的1201名患者.
- 患有复杂分叉病变的患者被随机分配1:1到OCT引导的PCI或血管学引导的PCI.
- 主要终点是主要心脏不良事件 (MACE) 的组合,随访时间中位数为2年.
主要成果:
- 在2年后,OCT引导PCI组中的59名患者 (10.1%) 经历了MACE,而血管造影引导PCI组中的83名患者 (14.1%) 经历了MACE (HR,0.70;95%CI,0.50-0.98;P=0.035).
- 两组之间没有观察到与程序相关的并发症的显著差异.
- 在这两组患者中,很大一部分患有涉及左侧冠状动脉的复杂病变.
结论:
- 与血管学引导的PCI相比,OCT引导的PCI与患有复杂冠状动脉分支病变的患者在2年内出现MACE的发病率较低.
- 常规的OCT指南表明,在管理复杂的冠状动脉分支病变方面,有潜在的益处.
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