Khalifa Amir Kh M, Kubo Takashi, Shimamura Kunihiro, Ino Yasushi, Kishk Yehia Taha, Hasan-Ali Hosam, Abdel-Galeel Ahmed, Terada Kosei, Emori Hiroki, Higashioka Daisuke, Takahata Masahiro, Shiono Yasutsugu, Akasaka Takashi
Department of Cardiovascular Medicine, Wakayama Medical University.
Department of Cardiovascular Medicine, Assiut University Hospitals.
Circ J. 2021 Sep 24;85(10):1781-1788. doi: 10.1253/circj.CJ-20-0942. Epub 2021 Jan 20.
Optical coherence tomography (OCT) provides valuable information to guide percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) regarding lesion preparation, stent sizing, and optimization. The aim of the present study was to compare lumen expansion of stent-treated lesions immediately after the procedure for ACS between OCT-guided PCI and angiography-guided PCI.
This study investigated stent-treated lesions immediately after PCI for ACS by using quantitative coronary angiography in 390 patients; 260 patients with OCT-guided PCI and 130 patients with angiography-guided PCI. Before stenting, the frequency of pre-dilatation and thrombus aspiration were not different between the OCT-guided and angiography-guided PCI groups. Stent diameter was significantly larger as a result of OCT-guided PCI (3.11±0.44 mm vs. 2.99±0.45 mm, P=0.011). In post-dilatation, balloon pressure-up (48% vs. 31%, P=0.001) and balloon diameter-up (33% vs. 6%, P<0.001) were more frequently performed in the OCT-guided PCI group. Minimum lumen diameter (2.55±0.35 mm vs. 2.13±0.50 mm, P<0.001) and acute lumen gain (2.18±0.54 mm vs. 1.72±0.63 mm, P<0.001) were significantly larger in the OCT-guided PCI group. Percent diameter stenosis (14±4% vs. 24±10%, P<0.001) and percent area stenosis (15±5% vs. 35±17%, P<0.001) were significantly smaller in the OCT-guided PCI group.
OCT-guided PCI potentially results in larger lumen expansion of stent-treated lesions immediately after PCI in the treatment of ACS compared with angiography-guided PCI.
光学相干断层扫描（OCT）可为急性冠状动脉综合征（ACS）患者的经皮冠状动脉介入治疗（PCI）提供有关病变预处理、支架尺寸选择及优化的重要信息。本研究旨在比较OCT引导下PCI与血管造影引导下PCI治疗ACS术后即刻支架治疗病变的管腔扩张情况。
本研究采用定量冠状动脉造影对390例ACS患者PCI术后即刻的支架治疗病变进行研究，其中260例接受OCT引导下PCI，130例接受血管造影引导下PCI。在支架置入前，OCT引导组与血管造影引导组的预扩张及血栓抽吸频率无差异。OCT引导下PCI置入的支架直径显著更大（3.11±0.44 mm对2.99±0.45 mm，P=0.011）。在后扩张中，OCT引导下PCI组更频繁地进行球囊压力上调（48%对31%，P=0.001）和球囊直径上调（33%对6%，P<0.001）。OCT引导下PCI组的最小管腔直径（2.55±0.35 mm对2.13±0.50 mm，P<0.001）和急性管腔增益（2.18±0.54 mm对1.72±0.63 mm，P<0.001）显著更大。OCT引导下PCI组的直径狭窄百分比（14±4%对24±10%，P<0.001）和面积狭窄百分比（15±5%对35±17%，P<0.001）显著更小。
与血管造影引导下PCI相比，OCT引导下PCI在治疗ACS时可能使PCI术后即刻支架治疗病变的管腔扩张更大。
