冠状动脉支架置入术后残余斑块负荷的预测因素及影响：一项血管内超声研究

Predictors and implications of residual plaque burden after coronary stenting: an intravascular ultrasound study.

作者信息

Alfonso Fernando, García Pablo, Pimentel Gela, Hernández Rosana, Sabaté Manel, Escaned Javier, Bañuelos Camino, Fernández Cristina, Macaya Carlos

机构信息

Interventional Cardiology Unit, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain.

出版信息

Am Heart J. 2003 Feb;145(2):254-61. doi: 10.1067/mhj.2003.49.

DOI:10.1067/mhj.2003.49

PMID:12595842

Abstract

BACKGROUND

Residual plaque burden after coronary stenting may be visualized by use of intravascular ultrasound. Determinants and implications of residual atherosclerotic plaque burden after coronary stenting are not well established. In particular, the implications of residual plaque burden, after adjusting for confounding factors, are still unknown.

METHODS

Sixty-two consecutive patients (age 56 +/- 9 years) undergoing coronary stenting under intravascular ultrasound imaging guidance were prospectively studied. A total of 616 slices were analyzed (every 2 mm of stent length) from motorized pull-back recordings. Residual plaque burden was calculated as residual plaque/vessel area x 100.

RESULTS

In 565 slices (89%), both residual plaque area and stent area could be measured. Mean residual plaque burden was 46.5% +/- 6%. By use of multiple regression analysis, lesion plaque area and reference segment plaque burden were identified as independent predictors of residual plaque burden after stenting. In addition, a significant correlation was found between residual plaque burden and most relevant angiographic parameters at follow-up (including minimal lumen diameter, percent diameter stenosis, and loss index), which persisted after adjustment. Furthermore, stents with a residual plaque burden >or=46% had higher a restenosis rate (relative risk [RR] 4.4, 95% CI 1.09-18.2, P =.03). On logistic regression analysis, residual plaque burden (RR 4.8, 95% CI 4.1-5.6, P =.01) and diabetes (RR 4.3, 95% CI 3.6-5.1, P =.03) emerged as the only independent predictors of restenosis.

CONCLUSIONS

The amount of residual plaque burden after coronary stenting plays an independent role on the late angiographic outcome of these patients.

摘要

背景

冠状动脉支架置入术后的残余斑块负荷可通过血管内超声进行可视化观察。冠状动脉支架置入术后残余动脉粥样硬化斑块负荷的决定因素及影响尚未完全明确。特别是，在调整混杂因素后，残余斑块负荷的影响仍不清楚。

方法

对62例（年龄56±9岁）在血管内超声成像引导下进行冠状动脉支架置入术的连续患者进行前瞻性研究。从电动回撤记录中总共分析了616个切片（每2毫米支架长度）。残余斑块负荷计算为残余斑块/血管面积×100。

结果

在565个切片（89%）中，残余斑块面积和支架面积均可测量。平均残余斑块负荷为46.5%±6%。通过多元回归分析，病变斑块面积和参照节段斑块负荷被确定为支架置入术后残余斑块负荷的独立预测因素。此外，随访时残余斑块负荷与大多数相关血管造影参数（包括最小管腔直径、直径狭窄百分比和丢失指数）之间存在显著相关性，调整后这种相关性仍然存在。此外，残余斑块负荷≥46%的支架再狭窄率较高（相对风险[RR]4.4，95%CI 1.09 - 18.2，P = 0.03）。在逻辑回归分析中，残余斑块负荷（RR 4.8，95%CI 4.1 - 5.6，P = 0.01）和糖尿病（RR 4.3，95%CI 3.6 - 5.1，P = 0.03）是再狭窄的唯一独立预测因素。