CAG与OCT评价DCB行PCI时的冠状动脉管腔变化的差异

目的:探索冠状动脉(冠脉)原位病变预处理成功的光学相干断层成像技术(OCT)标准及OCT在冠脉原位病变精准介入中的临床价值.方法:选取2020年9月-2021年7月上海交通大学医学院附属第九人民医院冠脉造影(CAG)后需要血运重建,适合行经皮冠脉介入且倾向非植入,并同意行OCT检查的冠心病患者,共30例(31处病变)....

Difference between CAG and OCT in evaluating the changes of coronary lumen during PCI with DCB

Objective: To explore the criteria of optical coherence tomography for the successful pretreatment of coronary artery in situ lesion and observe the clinical value of optical coherence tomography in the precise intervention of coronary in situ lesions. Methods: From September, 2020 to July, 2021, 30 patients with coronary heart disease(except for acute ST segment elevation myocardial infarction within 1 month) who needed revascularization after coronary angiography and suitable for coronary intervention(PCI) and predisposed to non-implantation therapy and agreed to accept OCT examination were selected in the Department of Cardiology of Ninth People’s Hospital of School of Medicine of Shanghai Jiaotong University. OCT was performed before and after pretreatment, and after drug-coated balloon or drug-eluting stent implantation. The data and treatment decision guided by OCT and coronary angiography were compared. And then we observed the success rate of pretreatment and the change of treatment decision guided by OCT. Results: Among the 30 patients and 31 lesions, according to the criteria of coronary arteriography, 28(90.3%) lesions were pretreated successfully, and 3 Lesions failed to be pretreated, in which one(3.2%) lesion showed elastic retraction, and 2 lesions(6.5%) showed type C dissection. According to the criteria of OCT, 15(48.4%) lesions were pretreated successfully, and 16(52.6%) lesions failed to be pretreated due to dissection appeared after pretreatment. There was a significant difference in treatment decision-making between the two pretreatment success criteria(P<0.001). The Minimum reference diameter of residual stenosis guided by OCT was larger than that guided by coronary angiography(2.93 ± 0.07 mm vs. 2.77 ± 0.26 mm, P=0.002). Conclusion: OCT is more accurate, definite, objective and has higher clinical value than coronary angiography in guiding PCI.