Nishiguchi Tsuyoshi, Tanaka Atsushi, Taruya Akira, Ozaki Yuichi, Nakai Mai, Teraguchi Ikuko, Ota Shingo, Kuroi Akio, Kameyama Takeyoshi, Yamano Takashi, Yamaguchi Tomoyuki, Matsuo Yoshiki, Ino Yasushi, Kubo Takashi, Hozumi Takeshi, Akasaka Takashi
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
J Cardiol. 2017 Dec;70(6):524-529. doi: 10.1016/j.jjcc.2017.03.009. Epub 2017 May 11.
Although about half of patients with spontaneous coronary artery dissection (SCAD) face ongoing necrosis, conservative therapy is recommended due to a high complication rate in angiography-guided percutaneous coronary intervention (PCI). The aim of this study was to investigate clinical outcomes of SCAD treated by optical coherence tomography (OCT)-guided PCI.
This study consisted of consecutive 306 patients with acute coronary syndrome (ACS) who underwent OCT-guided PCI. Based on the culprit lesion morphology by OCT, patients were assigned to four groups: a SCAD group, a plaque rupture (PR) group, a calcified nodule (CN) group, and an undetermined etiology (UE) group. Successful PCI was defined as thrombolysis in myocardial infarction flow grade 3 in final angiography without any complications. Primary endpoint was defined as occurrence rate of major adverse cardiac events (MACE) including cardiac death, myocardial infarction, and unstable angina pectoris.
OCT revealed 12 SCADs, 149 PRs, 16 CNs, and 129 UEs, respectively. No significant difference was observed in the success rate of PCI (SCAD 91.7%, PR 85.2%, CN 81.2%, UE 86.8%, p=0.88), while wire repositioning was needed in 2 SCAD cases (p<0.01). The mean follow-up periods were 17.1±13.3 months. No significant difference was observed in MACE among the groups (p=0.56).
The clinical outcomes of OCT-guided PCI for SCAD were favorable, as well as those for other ACS etiologies. OCT-guided PCI could become a therapeutic option for SCAD compromised with ongoing necrosis.
虽然约一半的自发性冠状动脉夹层（SCAD）患者面临持续坏死，但由于血管造影引导的经皮冠状动脉介入治疗（PCI）并发症发生率高，故推荐保守治疗。本研究旨在探讨光学相干断层扫描（OCT）引导下PCI治疗SCAD的临床结局。
本研究纳入连续306例接受OCT引导下PCI的急性冠状动脉综合征（ACS）患者。根据OCT显示的罪犯病变形态，将患者分为四组：SCAD组、斑块破裂（PR）组、钙化结节（CN）组和病因不明（UE）组。成功PCI定义为最终血管造影时心肌梗死溶栓血流3级且无任何并发症。主要终点定义为主要不良心脏事件（MACE）的发生率，包括心源性死亡、心肌梗死和不稳定型心绞痛。
OCT分别显示12例SCAD、149例PR、16例CN和129例UE。PCI成功率无显著差异（SCAD 91.7%，PR 85.2%，CN 81.2%，UE 86.8%，p = 0.88），但2例SCAD病例需要重新调整导丝位置（p < 0.01）。平均随访期为17.1±13.3个月。各组间MACE无显著差异（p = 0.56）。
OCT引导下PCI治疗SCAD的临床结局良好，其他ACS病因的情况也是如此。OCT引导下PCI可能成为因持续坏死而病情复杂的SCAD的一种治疗选择。
