Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan.
PLoS One. 2020 Aug 10;15(8):e0237362. doi: 10.1371/journal.pone.0237362. eCollection 2020.
Since the long fluoroscopy time in primary PCI for ST-segment elevation myocardial infarction (STEMI) could be an indicator of delayed reperfusion, it should be important to recognize which types of lesions require longer fluoroscopy-time in primary PCI. The purpose of this study was to investigate the association of the long fluoroscopy-time with clinical factors in primary percutaneous coronary interventions (PCI).
A total of 539 patients who underwent primary PCI were divided into the conventional fluoroscopy-time group (Q1-Q4: n = 434) and the long fluoroscopy-time group (Q5: n = 105) according to the quintile of the total fluoroscopy time in primary PCI. Univariate and multivariate logistic regression analyses were performed to find associations between clinical variables and the long fluoroscopy-time.
In univariate logistic regression analysis, prevalence of diabetes mellitus, hemodialysis, and previous CABG were significantly associated with the long fluoroscopy-time. In addition, complex lesion characteristics such as lesion length, lesion angle, tortuosity, and calcification were associated with the long fluoroscopy-time. In multivariable logistic regression analysis, lesion length [per 10 mm incremental: odds ratio (OR) 1.751, 95% confidence interval (CI) 1.397-2.195, P<0.001], moderate-excessive tortuosity (vs. mild tortuosity: OR 4.006, 95% CI 1.498-10.715, P = 0.006), and moderate to severe calcification (vs. none-mild calcification: OR 1.865, 95% CI 1.107-3.140, P = 0.019) were significantly associated with the long fluoroscopy-time.
In primary PCI for STEMI, diffuse long lesion, tortuosity, and moderate-severe calcification were associated with the long fluoroscopy-time. These complex features require special attention to reduce reperfusion time in primary PCI.
由于 ST 段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PCI）的透视时间较长可能是再灌注延迟的一个指标，因此，识别哪些类型的病变需要在直接 PCI 中花费更长的透视时间就显得尤为重要。本研究旨在探讨直接 PCI 中透视时间较长与临床因素的相关性。
根据直接 PCI 中透视时间的五分位数，将 539 例行直接 PCI 的患者分为常规透视时间组（Q1-Q4：n=434）和长透视时间组（Q5：n=105）。采用单因素和多因素逻辑回归分析来发现临床变量与长透视时间之间的关系。
单因素逻辑回归分析显示，糖尿病、血液透析和既往 CABG 与长透视时间显著相关。此外，病变长度、病变角度、迂曲和钙化等复杂病变特征也与长透视时间相关。多因素逻辑回归分析显示，病变长度（每增加 10mm：比值比[OR]1.751，95%置信区间[CI]1.397-2.195，P<0.001）、中度至重度迂曲（与轻度迂曲相比：OR 4.006，95%CI 1.498-10.715，P=0.006）和中重度钙化（与无-轻度钙化相比：OR 1.865，95%CI 1.107-3.140，P=0.019）与长透视时间显著相关。
在 STEMI 的直接 PCI 中，弥漫性长病变、迂曲和中重度钙化与长透视时间相关。这些复杂特征需要特别注意，以减少直接 PCI 的再灌注时间。
