用血管内超声波和光学一致性断层扫描指导在皮肤冠状动脉干预中的结果
Shilpkumar Arora1, Rahul Jaswaney2, Tasveer Khawaja3
1Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio.
The American journal of cardiology
|October 16, 2023
概括
使用血管内超声波 (IVUS) 和光学连贯性断层扫描 (OCT) 的冠状动脉内成像显著降低了经皮冠状动脉干预 (PCI) 患者的主要不良心脏事件和死亡率. 这些先进的成像技术在现实实践中改善了患者的治疗结果.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 医疗成像医学成像
背景情况:
- 穿皮冠状动脉干预 (PCI) 是治疗复杂冠状动脉病变的基石.
- 越来越多地使用诸如血管内超声波 (IVUS) 和光学连贯性断层扫描 (OCT) 等冠状动脉内成像模式.
- 关于IVUS和OCT在PCI中的比较有效性的真实数据至关重要.
研究的目的:
- 评估IVUS和OCT指南对大量PCI患者临床结果的影响.
- 为了比较接受IVUS或OCT指导的患者与没有接受IVUS或OCT指导的患者之间的重大心脏不良事件 (MACE) 和其他次要结果的发生率.
- 评估这些冠状动脉内成像技术的实际有效性.
主要方法:
- 使用全国再接收数据库 (2017-2019) 进行的回顾性队列研究.
- 包括1,118,475名接受PCI的患者,通过ICD代码识别IVUS和OCT使用情况.
- 多变量Cox比例危险回归分析,调整了混因子,以评估结果.
主要成果:
- IVUS指导 (7.7%的PCI) 与显著较低的MACE (6.5%与7.6%) 和改善的二次结果相关,包括NACE,全因死亡率,MI再入院和中风入院.
- 海外国家和地区指导 (0.5%的PCI) 也显示显著降低MACE (4.4%与7.6%相比),降低NACE和全因死亡率.
- 在IVUS中没有观察到紧急再血管化的显著差异,在OCT中也没有观察到MI,中风或紧急再血管化的显著差异.
结论:
- 在PCI期间的IVUS和OCT指导与大量现实患者群体中显著降低主要心脏不良事件,发病率和死亡率有关.
- 这些发现支持在复杂的PCI程序中常规使用冠心内成像.
- 进一步的研究可能会探索IVUS和OCT的特定适应症和最佳利用.
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