Nemoto Teruyoshi, Minami Yoshiyasu, Sato Toshimitsu, Muramatsu Yusuke, Kakizaki Ryota, Hashimoto Takuya, Oikawa Jun, Fujiyoshi Kazuhiro, Meguro Kentaro, Shimohama Takao, Tojo Taiki, Ako Junya
Department of Cardiovascular Medicine, Kitasato University School of Medicine.
Int Heart J. 2019 Sep 27;60(5):1022-1029. doi: 10.1536/ihj.18-565. Epub 2019 Sep 4.
Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) may increase contrast volume. However, the impact of OCT-guided PCI on the decline in kidney function (DKF) in actual clinical practice remains unclear.Among 1,003 consecutive patients who underwent either OCT-guided or intravascular ultrasound (IVUS)-guided PCI in our institute, we identified 202 propensity score-matched pairs adjusted by baseline factors. The incidence of DKF was compared between the OCT-guided PCI group and the IVUS-guided PCI group. DKF was defined as an increase in serum creatinine level of ≥ 0.5 mg/dL or a relative increase of ≥ 25% over baseline within 48 hours (acute DKF) or 1 month (sustained DKF) after PCI.Baseline characteristics, including the prevalence of chronic kidney disease (54% versus 46%, P = 0.09), were comparable between the OCT- and IVUS-guided PCI groups except for the age. The contrast volume was comparable between the two groups (153 ± 56 versus 144 ± 60 mL, P = 0.09), although it was significantly greater in the OCT-guided PCI group in patients with acute coronary syndrome (ACS; 175 ± 55 versus 159 ± 43 mL, P = 0.04). The incidence of acute DKF (0.5% versus 2.5%, P = 0.22) and sustained DKF (5.0% versus 10.4%, P = 0.31) was comparable between the two groups. Multivariate analysis demonstrated that ACS (odds ratio 4.74, 95% confidence interval 2.72-8.25, P < 0.001) was a predictor of sustained DKF.Compared with IVUS-guided PCI, OCT-guided PCI did not increase the incidence of DKF in actual clinical practice, although the increased contrast volume was observed in ACS cases.
光学相干断层扫描（OCT）引导下的经皮冠状动脉介入治疗（PCI）可能会增加造影剂用量。然而，在实际临床实践中，OCT引导下的PCI对肾功能下降（DKF）的影响仍不明确。在我院连续接受OCT引导或血管内超声（IVUS）引导下PCI的1003例患者中，我们通过基线因素确定了202对倾向评分匹配的患者。比较了OCT引导下PCI组和IVUS引导下PCI组的DKF发生率。DKF定义为PCI术后48小时内（急性DKF）或1个月内（持续性DKF）血清肌酐水平升高≥0.5mg/dL或较基线水平相对升高≥25%。
除年龄外，OCT引导和IVUS引导下PCI组的基线特征，包括慢性肾脏病患病率（54%对46%，P = 0.09）具有可比性。两组造影剂用量具有可比性（153±56对144±60 mL，P = 0.09），尽管在急性冠状动脉综合征（ACS）患者中，OCT引导下PCI组造影剂用量显著更高（175±55对159±43 mL，P = 0.04）。两组急性DKF发生率（0.5%对2.5%，P = 0.22）和持续性DKF发生率（5.0%对10.4%，P = 0.31）具有可比性。多因素分析表明，ACS（比值比4.74，95%置信区间2.72 - 8.25，P < 0.001）是持续性DKF的预测因素。
与IVUS引导下的PCI相比，在实际临床实践中，OCT引导下的PCI并未增加DKF的发生率，尽管在ACS病例中观察到造影剂用量增加。
