Iakovou Ioannis, Mintz Gary S, Dangas George, Abizaid Alexandre, Mehran Roxana, Lansky Alexandra J, Kobayashi Yoshio, Hirose Makoto, Ashby Dale T, Stone Gregg W, Moses Jeffrey W, Leon Martin B
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York 10022, USA.
Am J Cardiol. 2003 Nov 15;92(10):1171-6. doi: 10.1016/j.amjcard.2003.07.025.
Despite similar early clinical events, patients who undergo treatment of small vessels are at an increased risk for target lesion revascularization (TLR) after coronary artery stenting. We sought to determine predictors of TLR after stent implantation in small coronary arteries. We identified 423 consecutive patients who underwent intravascular ultrasound (IVUS)-guided small vessel stenting procedures in 465 coronary lesions with an angiographic reference vessel diameter of <2.75 mm. Patients were divided into 2 groups based on a final IVUS lumen area of < or =6.0 mm2 (n=345 lesions, group I) and >6.0 mm2 (n=115, group II). Baseline patient characteristics and in-hospital outcomes were similar between the 2 groups, except for a higher rate of restenotic lesions in group I and bifurcation lesions in group II. Group I had higher TLR rates at 1 year compared with group II patients (39% vs 26%, p = 0.02). The TLR rate appeared to decrease with greater stent expansion, especially at >90% of the reference vessel area, as assessed by IVUS. By multivariate analysis, an IVUS final stent area of < or =6 mm2, diabetes, absence of prior myocardial infarction, and history of intervention were independent predictors of 1-year TLR in this population. Final stent area of >6.0 mm2 and greater stent expansion were associated with a decrease in TLR. Therefore, there does not appear to be any "downside" to aggressive stent implantation strategies in small vessels. In contrast, IVUS allows maximization of final lumen dimensions to minimize clinical restenosis.
尽管早期临床事件相似，但接受小血管治疗的患者在冠状动脉支架置入术后发生靶病变血管重建（TLR）的风险增加。我们试图确定小冠状动脉支架置入术后TLR的预测因素。我们纳入了423例连续患者，这些患者在465个血管造影参考血管直径<2.75 mm的冠状动脉病变中接受了血管内超声（IVUS）引导下的小血管支架置入术。根据最终IVUS管腔面积≤6.0 mm²（n = 345个病变，I组）和>6.0 mm²（n = 115，II组）将患者分为两组。两组患者的基线特征和院内结局相似，除了I组再狭窄病变发生率较高，II组分叉病变发生率较高。与II组患者相比，I组1年时的TLR发生率更高（39%对26%，p = 0.02）。根据IVUS评估，TLR发生率似乎随着支架扩张程度的增加而降低，尤其是在参考血管面积>90%时。通过多因素分析，IVUS最终支架面积≤6 mm²、糖尿病、无既往心肌梗死和干预史是该人群1年TLR的独立预测因素。最终支架面积>6.0 mm²和更大的支架扩张与TLR降低相关。因此，在小血管中积极的支架置入策略似乎没有任何“不利之处”。相比之下，IVUS可使最终管腔尺寸最大化，以尽量减少临床再狭窄。
