复杂冠状动脉病变和慢性病患者的血管内成像
Woochan Kwon1, Ki Hong Choi1, Young Bin Song1
1Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
在接受复杂的皮肤冠状动脉干预的患者中,血管内成像指导显著减少了目标血管衰竭,无论慢性病 (CKD) 是否存在. 最大的益处在3期CKD患者中.
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
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 患有慢性病 (CKD) 的患者经常出现复杂的冠状动脉病变,需要穿皮冠状动脉干预 (PCI).
- 血管内成像指导可能有助于优化复杂病变的PCI,特别是在高风险的CKD人群中.
研究的目的:
- 为了确定血管内成像指导PCI后的结果是否根据CKD的存在或不存在而有所不同.
- 评估血管内成像与传统血管造影在指导PCI复杂冠状动脉病变的疗效,在患有和没有CKD的患者.
主要方法:
- 一个预先规定的RENOVATE-COMPLEX-PCI随机临床试验的副研究.
- 1639名患有复杂冠状动脉病变的患者被分为CKD (296) 和非CKD (1343) 组.
- 使用血管内成像指导或常规血管造影指导进行PCI.
主要成果:
- 血管内成像指导在CKD (13.3%对23.3%) 和非CKD (6.4%对9.9%) 组中,在3年内显著降低了目标血管衰竭 (TVF) 的初级终点.
- 在CKD组中,TVF的减少主要是由于心脏死亡或与目标血管相关的心肌梗塞的减少,而在非CKD组中则是由于目标血管的再血管化.
- 中度CKD患者 (GFR 30-60 mL/min/1.73m2) 显示,成像指导PCI的最大益处是 (8.8%对21.2%).
结论:
- 静脉内成像指导在复杂的PCI中比单独的血管造影提供了显著的临床益处,无论CKD状态如何.
- 该研究强调了成像指导在3期CKD患者中的特殊优势,并建议为这一群体量身定制的方法.
- 临床试验.gov 标识符:NCT03381872.
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