血管内超声和光学相干断层扫描在旋转式动脉粥样硬化切除术患者中的应用:基于大型国家登记处的分析

W. Siłka, Michał Kuzemczak, Krzysztof P Malinowski, Łukasz Kołtowski, Kinga Glądys, Mariola Kłak, Ewa Kowacka, Damian Grzegorek, Piotr J Wacinski, M. Chyrchel, M. Dziarmaga, Sylwia Iwańczyk, M. Jaguszewski, W. Wańha, Wojciech Wojakowski, F. D’Ascenzo, Zbigniew Siudak, R. Januszek
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引用次数: 0

摘要

背景:血管内超声(IVUS)和光学相干断层扫描(OCT血管内超声(IVUS)和光学相干断层扫描(OCT)已被证明可改善特定患者经皮冠状动脉介入治疗(PCI)的临床效果。目的:该研究旨在探讨在PCI和旋转动脉粥样硬化切除术(RA-PCI)中使用OCT或IVUS是否会增加血管再通成功的几率,血管再通成功的定义为心肌梗死溶栓治疗(TIMI)3级血流。研究方法数据来自波兰心脏病学会心血管介入协会(AISN)维护的全国 PCI 登记处 (ORPKI)。数据集包括 2014 年 1 月至 2021 年 12 月期间的 PCI。结果:共分析了6522例RA-PCI,其中708例(10.9%)由IVUS引导,86例(1.3%)由OCT引导。在血管内成像引导下进行的 RA-PCI 中,术后达到 TIMI 3 血流的比例明显更高(98.7% 对 96.6%,P < 0.0001)。多变量分析显示,使用 IVUS 和 OCT 可使术后 TIMI 3 血流的成功率分别增加 67%(几率比 (OR),1.67;95% 置信区间 (CI):1.40-1.99;p < 0.0001)和 66%(OR,1.66;95% CI:1.09-2.54;p = 0.02)。与成功血管再通相关的其他因素如下:既往接受过 PCI(OR,1.72;P < 0.0001)和冠状动脉搭桥术(OR,1.09;P = 0.002)、高血压(OR,1.14;P < 0.0001)、血管造影时的分数血流储备评估(OR,1.47;P < 0.0001)、分叉 PCI(OR,3.06;P < 0.0001)和支架植入(OR,19.6,P < 0.0001)。结论在血管内成像模式(IVUS 或 OCT)的引导下进行旋转动脉粥样硬化术与血管引导手术相比,具有更高的手术成功率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Usefulness of Intravascular Ultrasound and Optical Coherence Tomography in Patients Treated with Rotational Atherectomy: An Analysis Based on a Large National Registry
Background: Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been shown to improve the clinical outcomes of percutaneous coronary interventions (PCIs) in selected subsets of patients. Aim: The aim was to investigate whether the use of OCT or IVUS during a PCI with rotational atherectomy (RA-PCI) will increase the odds for successful revascularization, defined as thrombolysis in myocardial infarction (TIMI) 3 flow. Methods: Data were obtained from the national registry of PCIs (ORPKI) maintained by the Association of Cardiovascular Interventions (AISN) of the Polish Cardiac Society. The dataset includes PCIs spanning from January 2014 to December 2021. Results: A total of 6522 RA-PCIs were analyzed, out of which 708 (10.9%) were guided by IVUS and 86 (1.3%) by OCT. The postprocedural TIMI 3 flow was achieved significantly more often in RA-PCIs guided by intravascular imaging (98.7% vs. 96.6%, p < 0.0001). Multivariable analysis revealed that using IVUS and OCT was independently associated with an increased chance of achieving postprocedural TIMI 3 flow by 67% (odds ratio (OR), 1.67; 95% confidence interval (CI): 1.40–1.99; p < 0.0001) and 66% (OR, 1.66; 95% CI: 1.09–2.54; p = 0.02), respectively. Other factors associated with successful revascularization were as follows: previous PCI (OR, 1.72; p < 0.0001) and coronary artery bypass grafting (OR, 1.09; p = 0.002), hypertension (OR, 1.14; p < 0.0001), fractional flow reserve assessment during angiogram (OR, 1.47; p < 0.0001), bifurcation PCI (OR, 3.06; p < 0.0001), and stent implantation (OR, 19.6, p < 0.0001). Conclusions: PCIs with rotational atherectomy guided by intravascular imaging modalities (IVUS or OCT) are associated with a higher procedural success rate compared to angio-guided procedures.
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