中等程度冠状动脉病变的动脉重构对稳定性冠心病患者长期临床结局的影响：一项血管内超声研究。
Impact of Arterial Remodeling of Intermediate Coronary Lesions on Long-Term Clinical Outcomes in Patients with Stable Coronary Artery Disease: An Intravascular Ultrasound Study.
机构信息
Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China.
Department of Cardiology, Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 201900, China.
出版信息
J Interv Cardiol. 2021 Jun 11;2021:9915759. doi: 10.1155/2021/9915759. eCollection 2021.
BACKGROUND
Treatment of coronary intermediate lesions remains a controversy, and the role of arterial remodeling patterns determined by intravascular ultrasound in intermediate lesion is still not well known. The aim of this study was to investigate the impact of arterial remodeling of intermediate coronary lesions on long-term clinical outcomes.
METHODS
Arterial remodeling patterns were assessed in 212 deferred intermediate lesions from 162 patients after IVUS examination. Negative, intermediate, and positive remodeling was defined as a remodeling index of <0.88, 0.88∼1.0, and >1.0, respectively. The primary endpoint was the composite vessel-oriented clinical events, defined as the composition of target vessel-related cardiac death, target vessel-related myocardial infarction, and target vessel revascularization. Quantitative flow ratio was assessed for evaluating the functional significance of intermediate lesions.
RESULTS
72 intermediate remodeling lesions were present in 66 patients, whereas 77 negative remodeling lesions were present in 71 patients, and 63 positive remodeling lesions were present in 55 patients. Negative remodeling lesions had the smallest minimum lumen area (4.16 ± 1.03 mm vs. 5.05 ± 1.39 mm vs. 4.85 ± 1.76 mm; < 0.01), smallest plaque burden (63.45 ± 6.13% vs. 66.12 ± 6.82% vs. 71.17 ± 6.45%; < 0.01), and highest area stenosis rate (59.32% ± 10.15% vs. 54.61% ± 9.09% vs. 51.67% ± 12.96%; < 0.01). No significant difference was found in terms of quantitative flow ratio among three groups. At 5 years follow-up, negative remodeling lesions had a higher rate of composite vessel-oriented clinical event (14.3%), compared to intermediate (1.4%, =0.004) or positive remodeling lesions (4.8%, =0.06). After adjusting for multiple covariates, negative remodeling remained an independent determinant for vessel-oriented clinical event (HR: 4.849, 95% CI 1.542-15.251, =0.007).
CONCLUSION
IVUS-derived negative remodeling is associated with adverse long-term clinical outcome in stable patients with intermediate coronary artery stenosis.
背景
冠状动脉中间病变的治疗仍然存在争议，血管内超声（IVUS）确定的动脉重构模式在中间病变中的作用尚不清楚。本研究旨在探讨中间冠状动脉病变的动脉重构对长期临床结局的影响。
方法
对 162 例患者经 IVUS 检查后的 212 处延迟中间病变的动脉重构模式进行评估。将负性重构、中间性重构和正性重构定义为重构指数<0.88、0.88～1.0 和>1.0。主要终点是血管导向的复合临床事件，定义为靶血管相关死亡、靶血管相关心肌梗死和靶血管血运重建的组合。定量血流比评估用于评估中间病变的功能意义。
结果
66 例患者中有 72 处中间性重构病变，71 例患者中有 77 处负性重构病变，55 例患者中有 63 处正性重构病变。负性重构病变的最小管腔面积最小（4.16±1.03mm vs. 5.05±1.39mm vs. 4.85±1.76mm；<0.01），斑块负荷最小（63.45±6.13% vs. 66.12±6.82% vs. 71.17±6.45%；<0.01），面积狭窄率最高（59.32%±10.15% vs. 54.61%±9.09% vs. 51.67%±12.96%；<0.01）。三组间定量血流比无显著差异。5 年随访时，负性重构病变复合血管导向的临床事件发生率较高（14.3%），而中间性（1.4%，=0.004）或正性重构病变（4.8%，=0.06）发生率较低。在校正了多个混杂因素后，负性重构仍然是血管导向的临床事件的独立决定因素（HR：4.849，95%CI 1.542-15.251，=0.007）。
结论
在稳定型中间冠状动脉狭窄患者中，IVUS 检测到的负性重构与不良的长期临床结局相关。
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