Won Jumin, Hong Young Joon, Hyun Dae Yong, Jeong Hyung Ki, Oh Sung Sik, Kim Hyung Yoon, Kim Yongcheol, Park Hyukjin, Kim Min Chul, Cho Jae Yeong, Lee Ki Hong, Sim Doo Sun, Yoon Nam Sik, Yoon Hyun Ju, Kim Kye Hun, Park Hyung Wook, Kim Ju Han, Ahn Youngkeun, Jeong Myung Ho, Cho Jeong Gwan, Park Jong Chun
Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Chonnam Med J. 2018 Sep;54(3):190-196. doi: 10.4068/cmj.2018.54.3.190. Epub 2018 Sep 27.
We investigated predictors of major adverse cardiac events (MACE) with two years after medical treatment for lesions with angiographically intermediate lesions with intravascular ultrasound (IVUS) minimum lumen area (MLA) <4 mm in non-proximal epicardial coronary artery. We retrospectively enrolled 104 patients (57 males, 62±10 years) with angiographically intermediate lesions (diameter stenosis 30-70%) with IVUS MLA <4 mm in the non-proximal epicardial coronary artery with a reference lumen diameter between 2.25 and 3.0 mm. We evaluated the incidences of major adverse cardiovascular events (MACE including death, myocardial infarction, target lesion and target vessel revascularizations, and cerebrovascular accident) two years after medical therapy. During the two-year follow-up, 15 MACEs (14.4%) (including 1 death, 2 myocardial infarctions, 10 target vessel revascularizations, and 2 cerebrovascular accidents) occurred. Diabetes mellitus was more prevalent (46.7% vs. 18.0%, p=0.013) and statins were used less frequently in patients with MACE compared with those without MACE (40.0% vs. 71.9%, p=0.015). Independent predictors of MACEs with two years included diabetes mellitus (odds ratio [OR]=3.41; 95% CI=1.43-8.39, p=0.020) and non-statin therapy (OR=3.11; 95% CI=1.14-6.50, p=0.027). Long-term event rates are relatively low with only medical therapy without any intervention, so the cut-off of IVUS MLA 4 mm might be too large to be applied for defining significant stenosis. The predictors of long-term MACE were diabetes mellitus and statin therapy in patients with angiographically intermediate lesions in non-proximal epicardial coronary artery.
我们对非近端心外膜冠状动脉造影显示为中等病变且血管内超声（IVUS）最小管腔面积（MLA）<4mm的病变进行药物治疗后两年内的主要不良心脏事件（MACE）预测因素进行了研究。我们回顾性纳入了104例患者（57例男性，年龄62±10岁），这些患者非近端心外膜冠状动脉造影显示为中等病变（直径狭窄30-70%），IVUS MLA<4mm，参考管腔直径在2.25至3.0mm之间。我们评估了药物治疗两年后的主要不良心血管事件（MACE，包括死亡、心肌梗死、靶病变和靶血管血运重建以及脑血管意外）发生率。在两年的随访期间，发生了15例MACE（14.4%）（包括1例死亡、2例心肌梗死、10例靶血管血运重建和2例脑血管意外）。与无MACE的患者相比，糖尿病在MACE患者中更为普遍（46.7%对18.0%，p=0.013），且MACE患者使用他汀类药物的频率较低（40.0%对71.9%，p=0.015）。两年内MACE的独立预测因素包括糖尿病（比值比[OR]=3.41；95%置信区间=1.43-8.39，p=0.020）和非他汀类治疗（OR=3.11；95%置信区间=1.14-6.50，p=0.027）。仅进行药物治疗而无任何干预时，长期事件发生率相对较低，因此IVUS MLA 4mm的截断值可能太大，无法用于定义显著狭窄。非近端心外膜冠状动脉造影显示为中等病变患者长期MACE的预测因素是糖尿病和他汀类治疗。
