血管内超声成像对药物洗脱支架经皮冠状动脉介入治疗后早期和晚期临床结局的影响。

Impact of intravascular ultrasound imaging on early and late clinical outcomes following percutaneous coronary intervention with drug-eluting stents.

机构信息

Cardiovascular Research Foundation, Clinical Trial Center, New York, New York, USA.

出版信息

JACC Cardiovasc Interv. 2011 Sep;4(9):974-81. doi: 10.1016/j.jcin.2011.07.005.

DOI:10.1016/j.jcin.2011.07.005

PMID:21939937

Abstract

OBJECTIVES

This study sought to assess the impact of intravascular ultrasound (IVUS)-guided versus angiography-guided drug-eluting stent (DES) implantation.

BACKGROUND

There are limited data on IVUS guidance in the DES era. Therefore, we investigated the impact of IVUS guidance on clinical outcomes in the MATRIX (Comprehensive Assessment of Sirolimus-Eluting Stents in Complex Lesions) registry.

METHODS

The MATRIX registry prospectively enrolled consecutive, unselected patients treated with sirolimus-eluting stents (SES) (n = 1,504); 631 patients (42%) underwent IVUS-guided stenting, and 873 (58%) had only angiographic guidance. We assessed 30-day, 1-year, and 2-year rates of death/myocardial infarction (MI), major adverse cardiac events (cardiac death, MI, or target vessel revascularization), and definite/probable stent thrombosis in 548 propensity-score matched patient pairs.

RESULTS

After matching, baseline and angiographic characteristics were similar in IVUS and no-IVUS groups. Patients in the IVUS group had significantly less death/MI at 30 days (1.5% vs. 4.6%, p < 0.01), 1 year (3.3% vs. 6.5%, p < 0.01), and 2 years (5.0% vs. 8.8%, p < 0.01). Patients in the IVUS group had significantly less major adverse cardiac events at 30 days (2.2% vs. 4.8%, p = 0.04) and numerically less major adverse cardiac events at 1 year (9.1% vs. 13.5%, p = 0.07) and 2 years (12.9% vs. 16.7%, p = 0.18). Rates of MI were significantly lower in the IVUS group at 30 days (1.5% vs. 4.0%, p < 0.01), 1 year (1.8% vs. 4.8%, p < 0.01), and 2 years (2.1% vs. 5.7%, p < 0.01).

CONCLUSIONS

IVUS-guided stent implantation appears to be associated with a reduction in both early and long-term clinical events. Further investigation in randomized controlled trials is warranted.

摘要

目的

本研究旨在评估血管内超声（IVUS）指导与血管造影指导药物洗脱支架（DES）植入的影响。

背景

DES 时代 IVUS 指导的数据有限。因此，我们在 MATRIX（复杂病变中依维莫司洗脱支架的综合评估）注册研究中调查了 IVUS 指导对临床结局的影响。

方法

MATRIX 注册前瞻性纳入连续、未经选择的接受依维莫司洗脱支架（SES）治疗的患者（n=1504）；631 例（42%）患者接受 IVUS 指导支架置入，873 例（58%）仅接受血管造影指导。我们评估了 548 对倾向评分匹配患者对 30 天、1 年和 2 年的死亡率/心肌梗死（MI）、主要不良心脏事件（心脏死亡、MI 或靶血管血运重建）和确定/可能的支架血栓形成的发生率。

结果

匹配后，IVUS 组和无 IVUS 组的基线和血管造影特征相似。IVUS 组患者 30 天（1.5% vs. 4.6%，p<0.01）、1 年（3.3% vs. 6.5%，p<0.01）和 2 年（5.0% vs. 8.8%，p<0.01）的死亡率/MI 显著降低。IVUS 组患者 30 天（2.2% vs. 4.8%，p=0.04）和 1 年（9.1% vs. 13.5%，p=0.07）和 2 年（12.9% vs. 16.7%，p=0.18）的主要不良心脏事件发生率显著降低。IVUS 组患者 30 天（1.5% vs. 4.0%，p<0.01）、1 年（1.8% vs. 4.8%，p<0.01）和 2 年（2.1% vs. 5.7%，p<0.01）的 MI 发生率显著降低。