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依维莫司洗脱生物可吸收支架植入后急性支架回缩的预测因素:一项在天然冠状动脉中的光学相干断层扫描评估

Predictors of acute scaffold recoil after implantation of the everolimus-eluting bioresorbable scaffold: an optical coherence tomography assessment in native coronary arteries.

作者信息

Sato Takao, Jose John, El-Mawardy Mohamed, Sulimov Dmitriy S, Tölg Ralph, Richardt Gert, Abdel-Wahab Mohamed

机构信息

Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Am Kurpark 1, 23795, Bad Segeberg, Germany.

Cardiology, Tachikawa General Hospital, Nagaoaka, Japan.

出版信息

Int J Cardiovasc Imaging. 2017 Feb;33(2):145-152. doi: 10.1007/s10554-016-0997-7. Epub 2016 Oct 19.

Abstract

This study investigated the predictors of acute recoil after implantation of everolimus-eluting BRS based on optical coherence tomography (OCT). Thirty-nine patients (56 scaffolds) were enrolled. Acute absolute recoil by quantitative coronary angiography was defined as the difference between the mean diameter of the last inflated balloon (X) and the mean lumen diameter of BRS immediately after balloon deflation (Y). Acute percent recoil was defined as (X - Y) × 100/X. Plaque eccentricity (PE) and plaque composition (PC) were assessed by OCT. PC was classified into two different types: calcific (score = 1), fibrous and lipid (score = 0). Based on the mean acute scaffold recoil value of the present study, scaffolds were divided into two groups: the low acute recoil group (LAR, n = 34) and the high acute recoil group (HAR, n = 22). Acute percent and absolute recoil were 6.4 ± 3.0 % and 0.19 ± 0.11 mm. PE, PC score and scaffold/artery ratio were significantly higher in HAR than in LAR. In multivariate logistic regression analysis, PE > 1.49, PC score (score 1) and scaffold/artery ratio >1.07 were significant positive predictors for the occurrence of acute scaffold recoil (OR 10.7, 95 % CI 2.2-51.4, p < 0.01; OR 5.6, 95 % CI 1.9-22.0, p = 0.04; OR 12.4, 95 % CI 2.6-65.4, p < 0.01, respectively). Acute recoil of BRS is influenced by BRS sizing as well as OCT-derived plaque characteristics.

摘要

本研究基于光学相干断层扫描(OCT)调查了依维莫司洗脱生物可吸收支架(BRS)植入术后急性回缩的预测因素。纳入了39例患者(56个支架)。通过定量冠状动脉造影测定的急性绝对回缩定义为最后充盈球囊的平均直径(X)与球囊放气后即刻BRS的平均管腔直径(Y)之间的差值。急性百分比回缩定义为(X - Y)×100/X。通过OCT评估斑块偏心性(PE)和斑块成分(PC)。PC分为两种不同类型:钙化型(评分 = 1)、纤维和脂质型(评分 = 0)。根据本研究中支架急性回缩的平均值,将支架分为两组:低急性回缩组(LAR,n = 34)和高急性回缩组(HAR,n = 22)。急性百分比回缩和绝对回缩分别为6.4±3.0%和0.19±0.11 mm。HAR组的PE、PC评分和支架/动脉比显著高于LAR组。在多因素逻辑回归分析中,PE>1.49、PC评分(评分1)和支架/动脉比>1.07是急性支架回缩发生的显著正性预测因素(OR分别为10.7,95%CI 2.2 - 51.4,p<0.01;OR为5.6,95%CI 1.9 - 22.0,p = 0.04;OR为12.4,95%CI 2.6 - 65.4,p<0.01)。BRS的急性回缩受BRS尺寸以及OCT衍生的斑块特征影响。

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