血管内超声在冠状动脉临界病变中的应用研究

目的:研究传统冠状动脉定量分析方法(QCA)与血管内超声(IVUS)在冠状动脉临界病变中的应用。方法:共入选经过冠状动脉造影(至少4体位造影)证实病变狭窄处于临界病变的患者150例。将入选者分为:常规冠状动脉造影组90例(QCA),血管内超声组60例(IVUS)。通过QCA和血管内超声定量分析方法分析2组最小管腔直径、参考血管直径、直径狭窄率及最小管腔面积等参数指标;将相关数据建立直线回归分析方程,分析二者之间是否具有线性关系;采用Cox回归模型分析2组免于心血管事件方面差异,观察2组术后住院期间、30d、3个月、6个月、9个月和12个月主要心血管事件。结果:血管内超声组分别采用QCA和IVUS分析,参考血管直径2者具有正相关性分别为(3.28±0.19)mmvs.(3.17±0.21)mm,R=0.627。最小管腔直径分别为(2.04±0.18)mmvs.(2.0±0.17)mm,R=0.782。比较2组之间的参数:QCA组通过计算得出直径狭窄率,与IVUS管腔面积狭窄率之间无相关性(R20.05,P=0.222),IVUS最小管腔面积(4.7±0.67)mm2。通过COX回归模型显示2组在免于心血管事件方面的差异,可见QCA组发生心血管事件率具有较高的趋势。结论:对于临界病变的患者,采用IVUS的方法能够检测出更严重狭窄的发生率,传统冠状动脉造影判定结果往往低估真正的病变情况。对于临界病变的患者,采用IVUS进行测量分析,具有减低心血管事件风险的趋势。

The assessment of significance of intermediate coronary stenosis with intravascular ultrasound

Objective：To compare the detection of stenosis by angiography and identified angiographic predictors of severe luminal stenosis on intravascular ultrasound（IVUS）in patients with intermediate coronary stenosis.Methods：150 coronary intermediate stenosis patients underwent quantitative coronary angiography（QCA） and IVUS assessment of the lesions artery.The results from IVUS and QCA were compared using unpaired t-test.Multiple regression analysis was performed to identify parameters that could predict the presence of severe stenosis on IVUS.Results：30%-50% stenotic coronary lesions were classified as intermediate by QCA.There was a right correlation between IVUS and QCA with respect to percentage of stenosis,minimum luminal diameter,reference segment diameter.In contrast,there was a difference in the assessment luminal diameter stenosis with luminal area stenosis.The lesions were detected by IVUS could find the severity of stenosis,could reduce much MACE relatively.Conclusions：In patients with angiographically intermediate lesions,the frequency of severe stenosis detected by IVUS was high,indicating that angiography underestimated the severity of stenosis.IVUS could be used to stratify these lesions into groups to avoid higher risk of MACE.