Department of Cardiology, Hunan Provincial People's Hospital, Changsha, Hunan, China.
Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Provincial People's Hospital, Changsha, Hunan, China.
Catheter Cardiovasc Interv. 2021 May 1;97 Suppl 2:1072-1079. doi: 10.1002/ccd.29655. Epub 2021 Mar 25.
To investigate a strategy for ultra-low volume contrast percutaneous coronary intervention (PCI) with the aims of preserving renal function and observing the 90-day clinical endpoint in patients with non-ST-elevated myocardial infarction (non-STEMI) and chronic kidney disease (CKD).
The feasibility, safety, and clinical utility of PCI with ultra-low radio-contrast medium in patients with non-STEMI and CKD are unknown.
A total of 29 patients with non-STEMI and CKD (estimated glomerular filtration rate [eGFR] of ≤60 ml/min/1.73 m ) were included. Ultra-low volume contrast PCI was performed after minimal contrast coronary angiography using zero contrast optical coherence tomography (OCT) guidance. Pre- and post-PCI angiographic measurements were performed using quantitative flow ratio (QFR) for pre-perfusion assessment and verifying improvement.
The median creatinine level was 2.1 (inter-quartile range 1.8-3.3), and mean eGFR was 48 ± 8 ml/min/1.73 m pre-PCI. During the PCI procedure, OCT revealed 15 (52%) cases of abnormalities post-dilation. There was no significant change in the creatinine level and eGFR in the short- or long-term, and no major adverse events were observed.
In non-STEMI patients with high-risk CKD who require revascularization, QFR and no contrast OCT-guided ultra-low contrast PCI may be performed safely without major adverse events.
探讨一种超低对比量经皮冠状动脉介入治疗（PCI）策略，旨在保护肾功能，并观察非 ST 段抬高型心肌梗死（NSTEMI）合并慢性肾脏病（CKD）患者的 90 天临床终点。
对于 NSTEMI 合并 CKD 患者，超低对比量 PCI 的可行性、安全性和临床实用性尚不清楚。
共纳入 29 例 NSTEMI 合并 CKD 患者（估算肾小球滤过率[eGFR]≤60ml/min/1.73m ）。在最小对比量冠状动脉造影后，采用零对比光学相干断层扫描（OCT）指导进行超低对比量 PCI。使用定量血流比（QFR）进行 PCI 前后的血管造影测量，以评估预灌注，并验证改善情况。
中位肌酐水平为 2.1（四分位间距 1.8-3.3），PCI 前平均 eGFR 为 48±8ml/min/1.73m 。在 PCI 过程中，OCT 显示 15 例（52%）患者在扩张后存在异常。短期和长期内，肌酐水平和 eGFR 均无显著变化，且未观察到重大不良事件。
对于需要血运重建的高危 CKD 的 NSTEMI 患者，QFR 指导下不使用对比剂的超低对比量 PCI 可能是安全的，且不会发生重大不良事件。
