The Prognostic Value of Intravascular Ultrasound-Guided Coronary Endothelial Diameter in Percutaneous Coronary Intervention: The UNIQUE-PCI Outcome Study.

IF 1.9 4区 医学 Q3 INTEGRATIVE & COMPLEMENTARY MEDICINE
Yao Li, Min Wang
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引用次数: 0

Abstract

Objectives: In the context of coronary artery disease (CAD) and percutaneous coronary intervention (PCI), it is essential to explore the variations in coronary endothelial diameter. Understanding these variations holds significance for the early diagnosis and treatment of CAD. This study aims to elucidate the relevance of coronary endothelial diameter in the broader landscape of CAD and PCI outcomes.

Methods: This study is a retrospective cohort study. Consecutive patients with CAD who underwent PCI during hospitalization were included. IVUS measured the endothelial diameter of the coronary artery, and the patients were divided into the endothelial diameter constricted group, normal group and dilated group. The primary endpoint event was all-cause death, and the secondary endpoint events were cardiac death, non-fatal myocardial infarction, and elective revascularization. Follow-up was completed from August 2021 to February 2022. The follow-up period from August 2021 to February 2022 was selected to capture a comprehensive view of long-term postoperative outcomes in coronary artery disease patients undergoing PCI, ensuring a contemporary and relevant assessment of the study endpoints.

Results: The study ultimately included 705 patients, which included 295 (41.8%) in the endothelial diameter constricted group, 410 (58.2%) in the endothelial diameter normal group and 221 (31.3%) in the endothelial diameter dilated group. Patients with dilated endothelial diameter experienced a reduction in 5-year all-cause mortality, cardiac mortality, non-fatal heart attack, and elective revascularization rates. Specifically, the 5-year all-cause mortality rate in the dilated group was 1.79 (95% CI: 1.07-3.00), cardiac mortality was 3.73 (95% CI: 1.27-10.95), non-fatal heart attack rate was 1.65 (95% CI: 0.99-2.75), and elective revascularization rate was 2.15 (95% CI: 1.30-3.60) (P < .05). The Cox proportional-hazards model indicated that age, AMI, and endothelial diameter expansion were identified as risk factors for 5-year all-cause mortality (P < .05). There was no statistically significant difference in the 5-year all-cause mortality, cardiogenic mortality, elective revascularization rate and non-fatal myocardial infarction rate.

Conclusions: Patients with dilated endothelial diameter had decreased 5-year all-cause mortality, cardiac mortality, non-fatal heart attack, and elective revascularization rates. IVUS evaluation of the diameter of the coronary endothelium prior to PCI can aid in the classification and prevention of CAD risk. The retrospective design and potential biases associated with hospitalization data, along with the absence of certain clinical parameters, should be considered when interpreting the findings. The IVUS evaluation of coronary endothelial diameter not only aids in risk classification but also has the potential to inform personalized treatment strategies, enhancing patient care in coronary artery disease.

血管内超声引导下冠状动脉内皮直径在经皮冠状动脉介入治疗中的预后价值:UNIQUE-PCI 结果研究》。
研究目的就冠状动脉疾病(CAD)和经皮冠状动脉介入治疗(PCI)而言,研究冠状动脉内皮直径的变化至关重要。了解这些变化对 CAD 的早期诊断和治疗具有重要意义。本研究旨在阐明冠状动脉内皮直径在更广泛的 CAD 和 PCI 结果中的相关性:本研究是一项回顾性队列研究。方法:本研究是一项回顾性队列研究,纳入了在住院期间接受 PCI 的连续 CAD 患者。IVUS测量冠状动脉内皮直径,并将患者分为内皮直径收缩组、正常组和扩张组。主要终点事件为全因死亡,次要终点事件为心源性死亡、非致死性心肌梗死和选择性血管重建。随访时间为 2021 年 8 月至 2022 年 2 月。选择2021年8月至2022年2月为随访期,是为了全面了解接受PCI治疗的冠心病患者术后的长期预后,确保对研究终点的评估具有时代性和相关性:研究最终纳入了 705 例患者,其中内皮直径收缩组 295 例(41.8%),内皮直径正常组 410 例(58.2%),内皮直径扩张组 221 例(31.3%)。内皮直径扩张组患者的 5 年全因死亡率、心脏病死亡率、非致命性心脏病发作率和选择性血管重建率均有所下降。具体来说,扩张组的 5 年全因死亡率为 1.79(95% CI:1.07-3.00),心脏死亡率为 3.73(95% CI:1.27-10.95),非致命性心脏病发作率为 1.65(95% CI:0.99-2.75),选择性血管再通率为 2.15(95% CI:1.30-3.60)(P < .05)。Cox比例危险模型显示,年龄、急性心肌梗死和内皮直径扩张是5年全因死亡率的危险因素(P < .05)。5年全因死亡率、心源性死亡率、选择性血管重建率和非致死性心肌梗死率在统计学上没有明显差异:结论:血管内皮直径扩张患者的 5 年全因死亡率、心源性死亡率、非致命性心肌梗死率和选择性血管重建率均有所下降。PCI术前对冠状动脉内皮直径进行IVUS评估有助于对CAD风险进行分类和预防。在解释研究结果时,应考虑到回顾性设计和住院数据的潜在偏差,以及某些临床参数的缺失。对冠状动脉内皮直径的 IVUS 评估不仅有助于风险分类,还可能为个性化治疗策略提供信息,从而加强对冠心病患者的护理。
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来源期刊
Alternative therapies in health and medicine
Alternative therapies in health and medicine INTEGRATIVE & COMPLEMENTARY MEDICINE-
CiteScore
0.90
自引率
0.00%
发文量
219
期刊介绍: Launched in 1995, Alternative Therapies in Health and Medicine has a mission to promote the art and science of integrative medicine and a responsibility to improve public health. We strive to maintain the highest standards of ethical medical journalism independent of special interests that is timely, accurate, and a pleasure to read. We publish original, peer-reviewed scientific articles that provide health care providers with continuing education to promote health, prevent illness, and treat disease. Alternative Therapies in Health and Medicine was the first journal in this field to be indexed in the National Library of Medicine. In 2006, 2007, and 2008, ATHM had the highest impact factor ranking of any independently published peer-reviewed CAM journal in the United States—meaning that its research articles were cited more frequently than any other journal’s in the field. Alternative Therapies in Health and Medicine does not endorse any particular system or method but promotes the evaluation and appropriate use of all effective therapeutic approaches. Each issue contains a variety of disciplined inquiry methods, from case reports to original scientific research to systematic reviews. The editors encourage the integration of evidence-based emerging therapies with conventional medical practices by licensed health care providers in a way that promotes a comprehensive approach to health care that is focused on wellness, prevention, and healing. Alternative Therapies in Health and Medicine hopes to inform all licensed health care practitioners about developments in fields other than their own and to foster an ongoing debate about the scientific, clinical, historical, legal, political, and cultural issues that affect all of health care.
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