在患有急性冠状动脉综合征的患者中,以血管内成像为指导的穿皮冠状动脉干预
Koki Takegawa1,2, Koshiro Kanaoka1, Yoshitaka Iwanaga1,3
1Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan.
概括
血管内成像,包括光学连贯性断层扫描 (OCT) 和血管内超声波 (IVUS),可显著减少经皮冠状动脉干预 (PCI) 后急性冠状动脉综合征 (ACS) 复发. 这项实践研究证实了它对日本患者的益处.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 医疗成像医学成像
背景情况:
- 经皮肤冠状动脉干预 (PCI) 后的重复性急性冠状动脉综合征 (ACS) 和目标血管衰竭是重大的临床挑战.
- 虽然血管内成像 (光学连贯断层扫描[OCT],血管内超声波[IVUS]) 有利于稳定的冠状动脉疾病,但其在ACS中的作用不太清楚.
研究的目的:
- 评估成像引导PCI与血管学引导PCI在减少ACS复发中的有效性.
- 利用全国范围的日本数据库进行全面的现实世界分析.
主要方法:
- 使用国家数据进行的回顾性观察研究 (2014年4月 - 2021年3月).
- 包括住院患有ACS,首次进行PCI的患者.
- 图像导向 (OCT/IVUS) 和血管学导向PCI组之间的结果比较,使用治疗权重的逆概率.
主要成果:
- 血管造影指导PCI,OCT指导PCI和IVUS指导PCI分别在32,044,22,748和297,944名患者中进行.
- 在研究期间,OCT和IVUS指导的PCI率增加.
- 与血管造影指导的PCI相比,CT指导的PCI (HR 0.81) 和IVUS指导的PCI (HR 0.76) 都与明显较低的ACS复发风险有关.
结论:
- 现实数据显示,在ACS患者中,越来越多地采用了OCT和IVUS引导的PCI.
- 与传统血管学指导相比,成像引导的PCI与ACS复发的风险降低有关.
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