血管内成像预测器与复杂的PCI后与心血管事件相关
Joo Myung Lee1, Sang Yoon Lee1, Woochan Kwon2
1Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center (J.M.L., Sang Yoon Lee, K.H.C., T.K.P., J.H.Y., S.-H.C., H.-C.G., Y.B.S., J.-Y.H.), Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Circulation. Cardiovascular interventions
|February 18, 2025
概括
血管内成像有助于指导复杂病变的皮肤冠状动脉干预 (PCI). 在PCI后,支架扩张不足 (最小支架面积<5.5mm2) 显著增加了目标病变失效的风险.
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:
- 血管内成像指导的穿皮冠状动脉干预 (PCI) 改善了复杂冠状动脉病变的结果,而不是血管学指导的PCI.
- 现代药物释放支架的亚最佳血管内成像发现 (支架扩张不足,错位,剖析) 的预后意义尚不清楚.
研究的目的:
- 评估非最佳静脉内影像检测结果对复杂冠状动脉病变PCI后临床结果的影响.
- 确定最小支架面积 (MSA) 和其他成像参数的预后值,以预测目标病变缺陷 (TLF).
主要方法:
- 来自RENOVATE-COMPLEX-PCI试验的数据分析,比较成像指导与血管学指导的PCI.
- 在897个非左侧主要病变中评估PCI后血管内成像发现 (MSA,支架不扩张,错位,剖析).
- 主要终点是目标病变衰竭 (TLF),包括心脏病死亡,心脏病发作,再血管化或支架血栓形成.
主要成果:
- 确定了5.5mm2的最佳MSA切线;MSA<5.5mm2显著增加了TLF风险 (4.8%与2.2%相比).
- 患有MSA≥5.5mm2但成像检测结果低于最佳的患者在数值上增加了TLF风险 (3.2%).
- 患有MSA<5.5mm2和低于最佳结果的患者具有显著增加的TLF风险 (4.7%).
结论:
- 在复杂病变的血管内成像指导PCI后,不充分的绝对支架扩张 (MSA<5.5mm2) 是较高TLF的独立预测因素.
- 低于最佳的PCI后血管内成像发现,包括相对支架不扩张,错位和剖析,似乎有助于TLF风险.
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