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在不受保护的左主冠状动脉疾病患者的交叉支架后,最优的最小支架面积

Ju Hyeon Kim¹, Do-Yoon Kang¹, Jung-Min Ahn¹

¹Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

|September 17, 2025

概括

在左侧主要冠状动脉 (LM) 中,支架的最佳扩张对于预防主要不良心脏事件 (MACE) 至关重要. 本研究定义了使用静脉内超声波 (IVUS) 来指导LM穿皮冠状动脉干预 (PCI) 的最小支架面积 (MSA) 门.

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:

与单独的血管造影相比,冠状动脉内成像改善了左主冠状动脉 (LM) 疾病的皮肤通冠状动脉干预 (PCI) 结果.
在LM PCI后预测心血管结果的最佳最小支架面积 (MSA) 值仍然未定义.

研究的目的:

为了评估LM交叉支架后血管内超声波 (IVUS) 测量的细分MSA.
建立最佳的MSA值来预测5年内发生的重大心脏不良事件 (MACE).

主要方法:

对829名患者进行IVUS引导的PCI,用于未受保护的LM疾病的回顾性分析,使用单片支架交叉技术.
最终的MSA测量在近端LM,远端LM和左前下垂动脉 (LAD) 骨架.
主要结局:5年MACE (因任何原因死亡,心肌梗塞,目标病变再血管化).

主要成果:

确定了用于预测5年MACE的MSA截止值:近距离LM11.4mm2,远距离LM8.4mm2,LAD ostium8.1mm2.
靠近的LM支架扩张不足显著增加了MACE风险 (调整后的HR2.34).
同时的远端LM和LAD骨不扩张明显增加了MACE风险 (调整HR 2.57).

结论:

足够的支架扩张在近距离的LM和避免在远距离的LM和LAD骨的不足扩张对于有利的长期结果至关重要.
确定的MSA值为优化LM PCI期间的支架放置提供了实际的基准.

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