频域光学相干断层扫描与血管内超声在经皮冠状动脉介入治疗中作为指导的比较实用性

Usefulness of Frequency Domain Optical Coherence Tomography Compared with Intravascular Ultrasound as a Guidance for Percutaneous Coronary Intervention.

作者信息

Kim In-Cheol, Yoon Hyuck-Jun, Shin Eun-Seok, Kim Min-Seok, Park Jincheol, Cho Yun-Kyeong, Park Hyoung-Seob, Kim Hyungseop, Nam Chang-Wook, Han Seong-Wook, Kim Yoon-Nyun, Kim Kwon-Bae, Hur Seung-Ho

机构信息

Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.

Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea.

出版信息

J Interv Cardiol. 2016 Apr;29(2):216-24. doi: 10.1111/joic.12276. Epub 2016 Mar 1.

DOI:10.1111/joic.12276

PMID:26927366

Abstract

OBJECTIVES

To compare outcomes and rates of optimal stent placement between optical coherence tomography (OCT) and intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI).

BACKGROUND

Unlike IVUS-guided PCI, rates of clinical outcomes and optimal stent placement have not been well characterized for OCT-guided PCI.

METHODS

The study enrolled 290 patients who underwent implantation of a second generation drug eluting stent under OCT (122 patients) or IVUS (168 patients) guidance. The two groups were compared after adjusting for baseline differences using 1:1 propensity score matching (PSM) (114 patients in each group). Optimal stent placement was defined as achieving an adequate lumen (optimal minimum stent area [MSA > 4.85 mm(2) for OCT, >5 mm(2) for IVUS] or a final MSA ≥ 90% of the distal reference lumen area, without edge dissection, incomplete stent apposition, or tissue prolapse), or otherwise performing additional interventions to address suboptimal post-stenting OCT or IVUS findings. The primary endpoint was one-year cumulative incidence of major adverse cardiac events (MACE; cardiac death, myocardial infarction and target lesion revascularization). Definite or probable stent thrombosis (ST) rates were evaluated.

RESULTS

In adjusted comparisons between OCT and IVUS groups, there was no significant difference in rates of MACE (3.5% vs. 3.5%, P = 1.000) and ST (0% vs. 0.9%, P = 1.000) at 1 year, optimal stent placement (89.5% vs. 92.1%, P = 0.492), and further intervention (7.9% vs.13.2%, P = 0.234), despite OCT significantly more frequently detecting tissue prolapse (97.4% vs. 47.4%, P < 0.001), and numerically more edge dissection (10.5% vs. 4.4%, P = 0.078) or incomplete stent apposition (48.2% vs. 36.8%, P = 0.082).

CONCLUSIONS

OCT guidance showed comparable results to IVUS in mid-term clinical outcomes, suggesting that OCT can be an alternative tool for stent placement optimization.

摘要

目的

比较光学相干断层扫描（OCT）和血管内超声（IVUS）引导下经皮冠状动脉介入治疗（PCI）的结果及最佳支架置入率。

背景

与IVUS引导的PCI不同，OCT引导的PCI的临床结果和最佳支架置入率尚未得到充分描述。

方法

该研究纳入了290例在OCT（122例患者）或IVUS（168例患者）引导下植入第二代药物洗脱支架的患者。使用1:1倾向评分匹配（PSM）对基线差异进行调整后比较两组（每组114例患者）。最佳支架置入定义为获得足够的管腔（最佳最小支架面积[OCT为>4.85 mm²，IVUS为>5 mm²]或最终支架面积≥远端参考管腔面积的90%，且无边缘夹层、支架贴壁不良或组织脱垂），否则针对支架置入后OCT或IVUS的欠佳表现进行额外干预。主要终点是主要不良心脏事件（MACE；心源性死亡、心肌梗死和靶病变血运重建）的一年累积发生率。评估明确或可能的支架血栓形成（ST）率。

结果

在OCT组和IVUS组的调整后比较中，1年时MACE发生率（3.5%对3.5%，P = 1.000）、ST发生率（0%对0.9%，P = 1.000）、最佳支架置入率（89.5%对92.1%，P = 0.492）和进一步干预率（7.9%对13.2%，P = 0.234）均无显著差异，尽管OCT更频繁地检测到组织脱垂（97.4%对47.4%，P < 0.001），边缘夹层（10.5%对4.4%，P = 0.078）或支架贴壁不良（48.2%对36.8%，P = 0.082）在数值上更多。