Iannaccone Mario, D'Ascenzo Fabrizio, Frangieh Antonio H, Niccoli Giampaolo, Ugo Fabrizio, Boccuzzi Giacomo, Bertaina Maurizio, Mancone Massimo, Montefusco Antonio, Amabile Nicolas, Sardella Gennaro, Motreff Pascal, Toutouzas Konstantinos, Colombo Francesco, Garbo Roberto, Biondi-Zoccai Giuseppe, Tamburino Corrado, Omedè Pierluigi, Moretti Claudio, D'amico Maurizio, Souteyrand Geraud, Meieir Pascal, Lüscher Thomas F, Gaita Fiorenzo, Templin Christian
"Città della Scienza e della Salute," Department of Cardiology, University of Turin, Turin, Italy.
Department of Cardiology, Zurich University Hospital, Zurich, Switzerland.
Catheter Cardiovasc Interv. 2017 Aug 1;90(2):E46-E52. doi: 10.1002/ccd.26880. Epub 2016 Dec 28.
To determine the potential clinical impact of OCT (Optical Coherence Tomography) during primary percutaneous coronary intervention in patients presenting with ACS (Acute Coronary Syndrome).
FORMIDABLE is a multicentre retrospective registry enrolling all patients presenting with ACS and treated with an OCT-guided approach, while the USZ registry enrolled patients treated with a standard angiography guided approach. Multivariate adjustment was performed via a propensity score matching. The number stents useds was the primary outcome, while the incidence of MACE (a composite of death, myocardial infarction, target vessel revascularization, and stent thrombosis) was the secondary endpoint. A total of 285 patients OCT-guided and 1,547 angiography guided patients were enrolled, resulting in 270 for each cohort after propensity score with matching. Two stents were used in 12% versus 34%; 3 stents in 8% versus 38% of the patients (P < 0.001). After a follow up of 700 days (450-890), there was no difference in myocardial infarction (6% vs. 6%, P = 0.86), while MACE (11% vs. 16%, P = 0.06), target vessel revascularization (2% vs. 4%, P = 0.15) and stent thrombosis rates (0% vs. 2.7%, P = 0.26) were numerically lower for the OCT-guided cohort but none of these endpoints did reach statistical significance.
An OCT-guided approach reduced the number of stents used, number of patients treated with more than one stent, while there was no statistically significant difference in clinical endpoints while most of them were numerically lower, including stent thrombosis rates. © 2016 Wiley Periodicals, Inc.
确定光学相干断层扫描（OCT）在急性冠状动脉综合征（ACS）患者的直接经皮冠状动脉介入治疗期间的潜在临床影响。
FORMIDABLE是一项多中心回顾性登记研究，纳入所有表现为ACS并接受OCT引导治疗的患者，而瑞士苏黎世大学医院（USZ）登记研究纳入接受标准血管造影引导治疗的患者。通过倾向得分匹配进行多变量调整。使用的支架数量是主要结局，而主要不良心血管事件（MACE，包括死亡、心肌梗死、靶血管血运重建和支架血栓形成的复合终点）的发生率是次要终点。共纳入285例接受OCT引导治疗的患者和1547例接受血管造影引导治疗的患者，倾向得分匹配后每个队列各有270例。使用两个支架的患者比例分别为12%和34%；使用三个支架的患者比例分别为8%和38%（P<0.001）。随访700天（450 - 890天）后，心肌梗死发生率无差异（6%对6%，P = 0.86），而OCT引导治疗组的MACE（11%对16%，P = 0.06）、靶血管血运重建（2%对4%，P = 0.15）和支架血栓形成率（0%对2.7%，P = 0.26）在数值上较低，但这些终点均未达到统计学显著性。
OCT引导治疗减少了支架使用数量以及接受多个支架治疗的患者数量，虽然临床终点无统计学显著差异，但大多数终点在数值上较低，包括支架血栓形成率。©2016威利期刊公司。
