根据临床表现对进行复杂PCI的患者进行静脉内成像指导式支架优化的影响
Sang Yoon Lee1, Ki Hong Choi1, Chan Joon Kim2
1Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
JACC. Cardiovascular interventions
|May 29, 2024
概括
在复杂的穿皮冠状动脉干预 (PCI) 中,血管内成像指导没有根据临床表现显示出各种益处. 然而,在急性冠状动脉综合征患者中,用静脉内成像优化支架显著降低了目标血管衰竭.
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:
- 静脉内成像 (IVI) 对复杂的皮肤冠状动脉干预 (PCI) 中的支架优化在不同患者呈现的临床益处仍然不清楚.
- 这项研究调查了IVI指导是否与基于患者临床状况的标准血管学指导相比具有差异性优势.
研究的目的:
- 为了比较IVI指导与血管学指导的PCI在复杂冠状动脉病变患者中的结果,按临床表现分层.
- 分析IVI对急性冠状动脉综合征 (ACS) 与慢性冠状动脉综合征 (CCS) 患者的目标血管衰竭 (TVF) 的影响.
主要方法:
- 对RENOVATE-COMPLEX-PCI试验的亚组分析,随机分配患有复杂冠状动脉病变的患者进行IVI引导或血管学引导的PCI (2:1比率).
- 主要终点是TVF,这是心脏死亡,目标血管-心肌梗塞或目标血管再血管化的复合结果.
- 根据初始呈现分析了结果:ACS或CCS.
主要成果:
- 在IVI治疗效果和临床表现之间没有发现显著的相互作用 (P=0.19).
- 在ACS患者中,TVF发生在IVI的10.4%,而血管造影的14.6% (HR0.74;P=0.18).
- 在CCS患者中,TVF发生在5.0%的IVI患者和10.4%的血管造影患者中 (HR 0.46;P=0.006).
- 通过IVI优化支架在ACS患者中降低了TVF (6.5%对14.1%;HR 0.49;P=0.02),但在CCS患者中没有 (5.4%对4.7%;HR 1.18;P=0.69).
结论:
- 在复杂的PCI中IVI指导的好处与TVF风险的临床表现没有显著的相互作用.
- 通过IVI实现的支架优化对于改善复杂PCI的ACS患者的治疗结果尤为重要.
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