冠状动脉内成像对支架血栓形成治疗的临床影响

G. Karamasis, Athanasios Katsikis, K. Konstantinou, G. Clesham, Paul A. Kelly, R. Jagathesan, Francesco Prati, Christos V. Bourantas, John R. Davies, Thomas R. Keeble
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引用次数: 0

摘要

目的:建议在支架血栓形成(ST)病例中使用冠状动脉内成像(ICI),量身定制的治疗似乎是合理的。然而,目前还缺乏支持这一策略的数据。本研究旨在评估 ICI 对 ST 治疗的临床影响。研究方法未经调整的研究对象是在一家三级心脏病中心就诊并接受经皮冠状动脉介入治疗(PCI)的明确 ST 连续患者。根据 PCI 操作者的实时 ICI 解读推测 ST 的主要机制。根据 ICI 的使用情况进行倾向评分匹配,形成调整后的人群,并应用卡普兰-梅尔分析比较无心脏性死亡(CD)或靶病变血运重建(TLR)的存活率。结果:未调整人群包括 130 名 ST 患者,其中大多数为 ST 段抬高型心肌梗死(STEMI)患者(88%)和极晚期 ST 患者(86%)。45 名患者进行了 ICI,其中 30 例进行了光学相干断层扫描(OCT)。如果将各个ST机制视为一组,则可观察到治疗类型(支架与非支架)和ST机制之间的交互作用,非支架治疗在扩张不足、错位、支架内再狭窄和机制不确定的病例中更为普遍。经过匹配后,30 名患者组成了两组。在 ICI 指导下进行治疗的患者在 2 年后无 CD-TLR 的存活率更高(93% 对 73%,P = 0.037)。结论在针对 ST 的 PCI 过程中,冠状动脉内成像引导对管理(支架与非支架)有直接影响,并且在应用倾向匹配分析时,中期随访的事件发生率更低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical Impact of Intracoronary Imaging in the Management of Stent Thrombosis
Objectives: Use of intracoronary imaging (ICI) in cases of stent thrombosis (ST) is recommended and tailored treatment appears reasonable. Nevertheless, data supporting such a strategy are lacking. The aim of this study was to evaluate the clinical impact of ICI in the management of ST. Methods: The unadjusted study population was consecutive patients with definite ST presenting in a single tertiary cardiac centre and undergoing percutaneous coronary intervention (PCI). The presumed major mechanism of ST was assigned according to the real-time ICI interpretation by the PCI operator. Propensity score matching was performed with regard to ICI use to form the adjusted population and Kaplan–Meier analysis was applied to compare survival free of cardiac death (CD) or target lesion revascularization (TLR). Results: The unadjusted population included 130 ST patients, with the majority presenting with ST-elevation myocardial infarction (STEMI) (88%) and very late ST (86%). ICI was performed in 45 patients, of whom optical coherence tomography (OCT) was performed in 30 cases. When the individual ST mechanisms were viewed as groups, there was an interaction observed between type of treatment (stent vs. non-stent) and ST mechanism, with non-stent treatment being more prevalent in cases of underexpansion, malapposition, in-stent restenosis and mechanism uncertainty. After application of matching, two groups of 30 patients were formed. ICI-guided management resulted in better survival free of CD–TLR at 2 years (93% vs. 73%, p = 0.037). Conclusions: Intracoronary imaging guidance during PCI for ST had a direct impact on management (stent vs. non-stent) and resulted in a lower event rate at mid-term follow-up when propensity matched analysis was applied.
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