Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University.
Int Heart J. 2021 Mar 30;62(2):282-289. doi: 10.1536/ihj.20-634. Epub 2021 Mar 17.
The clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) were comparable or even worse than those with ST-segment elevation myocardial infarction (STEMI). Although successful percutaneous coronary intervention (PCI) to the culprit lesions of NSTEMI would improve the clinical outcomes, some PCI require long fluoroscopy time, reflecting the difficulty of PCI. This study aims to find clinical factors associated with long fluoroscopy time in PCI to the culprit lesion of NSTEMI. We included 374 patients and divided those into the conventional fluoroscopy time (n = 302) and long fluoroscopy time (n = 72) groups according to the quintiles of fluoroscopy time. Clinical and angiographic parameters were compared between the two groups. Calcification and tortuosity were significantly more severe in the long fluoroscopy time group than in the conventional fluoroscopy time group. The prevalence of previous coronary artery bypass grafting (CABG) and bifurcation lesions was significantly greater in the long fluoroscopy time group than in the conventional fluoroscopy time group. In the multivariate stepwise logistic regression analysis, previous CABG (odds ratio [OR], 3.368; 95% confidence interval [CI], 1.407-8.064; P = 0.006), bifurcation lesion (OR, 2.407; 95% CI, 1.285-4.506; P = 0.006), excessive tortuosity (versus mild to moderate tortuosity; OR, 4.095; 95% CI, 1.159-14.476; P = 0.029), and moderate to severe calcification (versus none to mild; OR, 5.792; 95% CI, 3.254-10.310; P < 0.001) were significantly associated with long fluoroscopy time. In conclusion, previous CABG, bifurcation, excessive tortuosity, and moderate to severe calcification were associated with long fluoroscopy time. Our study provided a reference for PCI operators to identify the difficulties in PCI to the culprit lesion of NSTEMI.
非 ST 段抬高型心肌梗死（NSTEMI）患者的临床结局与 ST 段抬高型心肌梗死（STEMI）患者相当甚至更差。虽然成功进行经皮冠状动脉介入治疗（PCI）以治疗 NSTEMI 的罪犯病变可改善临床结局，但某些 PCI 需要较长的透视时间，反映出 PCI 的难度。本研究旨在寻找与 NSTEMI 罪犯病变 PCI 中透视时间长相关的临床因素。我们纳入了 374 名患者，并根据透视时间的五分位数将这些患者分为常规透视时间（n=302）和长透视时间（n=72）组。比较了两组之间的临床和血管造影参数。长透视时间组的钙化和迂曲程度明显比常规透视时间组严重。长透视时间组的既往冠状动脉旁路移植术（CABG）和分叉病变的发生率明显高于常规透视时间组。多变量逐步逻辑回归分析显示，既往 CABG（比值比[OR]，3.368；95%置信区间[CI]，1.407-8.064；P=0.006）、分叉病变（OR，2.407；95%CI，1.285-4.506；P=0.006）、严重迂曲（与轻度至中度迂曲相比；OR，4.095；95%CI，1.159-14.476；P=0.029）和中重度钙化（与无至轻度钙化相比；OR，5.792；95%CI，3.254-10.310；P<0.001）与长透视时间显著相关。总之，既往 CABG、分叉病变、严重迂曲和中重度钙化与长透视时间相关。我们的研究为 PCI 操作者提供了参考，以识别 NSTEMI 罪犯病变 PCI 中的困难。
