血管内超声指导冠状动脉中重度钙化病变介入治疗的效果

目的:评价血管内超声(IVUS)对冠状动脉中-重度钙化病变介入治疗的指导作用及对预后的影响。方法:2009年1月~2013年1月冠状动脉中-重度钙化病变患者219例接受冠状动脉介入治疗,其中95例患者术中应用血管内超声指导,124例患者在单纯冠状动脉造影(CAG)指导下完成介入治疗。结果:两组患者的临床基线特征、靶血管部位、病变类型、置入支架数目、长度、直径;冠状动脉旋磨和切割球囊应用等方面,差异均无统计学意义。两组患者住院期间及术后30 d临床终点事件,包括主要不良心血管事件(MACE)事件、支架内血栓发生率的差异均无统计学意义。随访12个月时,IVUS组MACE事件发生率显著低于CAG组(8.4%vs.17.7%,P0.05),IVUS组靶血管重建发生率显著低于CAG组(3.2%vs.10.5%,P0.05)。IVUS组与CAG组在支架内血栓发生率方面差异无统计学意义(3.2%vs.3.2%)。结论:IVUS指导中-重度冠状动脉钙化病变术后即刻和短期临床效果并不优于CAG,但应用IVUS指导能够显著降低术后1年靶血管重建发生率。

Application of intravascular ultrasound in patients with moderate and severe calcified coronary lesions

AIM： To assess the value of intravascular ultrasound （IVUS） in moderate or severe calcified coronary artery disease （CAD） and the prognosis. METHODS： Analysis was made in 219 patients with moderate or severe calcified CAD who underwent percutaneous coronary intervention （PCI） from January 2009 to January 2013. Of the 219 patients, 95 patients underwent PCI under the guidance of IVUS and 124 patients under the guidance of conventional coronary angiography （CAG）. RESULTS： No statistical difference was observed between groups in clinical baseline characteristics （including target vessel location, lesion type, number of implanted stents, length, diameter, coronary atherectomy and cutting bal- loon applications） and in clinical endpoints during hospitalization and 30 days after PCI （including MACE events and the incidence of stent thrombosis）. The 1-year follow-up found that the MACE event rate and the target vessel revascularization in IVUS group were significantly lower than those in CAG group （8.4% vs. 17.7% ; 3.2% vs. 10.5% ; both P 〈0.05）. No significant difference was seen in the incidence of stent thrombosis between groups. CONCLUSION： Although IVUS guidance produces no better immediate postoperative and short-term clinical effect in moderate or severe calcified CHD than that of CAG, the application of IVUS guidance can significantly reduce the postoperative 1-year incidence of target vessel revascularization.