光学相干断层成像指导与冠状动脉造影指导直接经皮冠状动脉介入治疗6个月随访结果的比较

目的比较光学相干断层成像(OCT)指导和单纯冠状动脉造影(CAG)指导直接冠状动脉介入治疗(PPCI)6个月的随访结果。方法前瞻性研究。连续入选2017年3月至2018年12月阜外医院因ST段抬高型心肌梗死(STEMI)行OCT指导的PPCI患者275例(OCT指导组)。收集全部入选患者的人口学资料、合并疾病、冠状动脉造影和OCT特征资料。采用倾向性评分从单纯CAG指导的PPCI患者数据库中1∶1回顾性顺序匹配275例患者(CAG指导组),对比两种策略对6个月临床随访结果的影响。结果OCT指导组中,OCT评估发现斑块脱垂151例(54.9%),支架贴壁不良113例(41.1%),支架近和/或远端夹层38例(13.8%),其中3例(1.1%)同时发生支架近端和远端夹层,38例远端夹层患者中,需行补救性置入支架2例。随访6个月结果显示,OCT指导组与CAG指导组比较,心血管死亡、再次心肌梗死、靶血管再次血运重建、卒中和出血终点事件差异均无统计学意义(P=0.682)。结论与单纯CAG指导相比,OCT指导的PPCI并不能降低6个月的临床终点事件。

Comparison of six-month follow-up results of primary percutaneous coronary intervention guided by optical coherence tomography or coronary angiography

Objective To compare the 6-month follow-up results of primary percutaneous coronary intervention(PPCI)guided by optical coherence tomography(OCT)or coronary angiography(CAG)alone in a larger ST-segment elevation myocardial infarction(STEMI)cohort.Methods We enrolled 275 STEMI patients undergoing OCT-guided PPCI from March 2017 through December 2018.Two hundred and seventy-five propensity score matched STEMI patients undergoing CAG-guided PPCI served as control group.The 6-month clinical follow-up results were compared between the two groups.The demographic data,complications,coronary angiography and OCT characteristics were evaluated.Results OCT evaluation showed that there were 151 patients(54.9%)with plaque prolapse and 113 patients(41.1%)with stent malposition.Proximal and/or distal dissection of stents occurred in 38 patients(13.8%),of which 3 patients(1.1%)had both proximal and distal dissection.Of the 38 patients,2 patients received rescue stent implantation.Results of clinical follow-up at 6 months showed that there was no significant difference in cardiovascular death,repeat myocardial infarction,target vessel revascularization,stroke and hemorrhage endpoint events between OCT-guided PPCI patients and CAG-guided PPCI patients(P=0.682).Conclusion Clinical events at 6 months are similar between OCT-guided PPCI and CAG-guided PPCI for STEMI patients.