单期与分期多支血管最佳血管内超声引导下经皮冠状动脉介入治疗用于慢性冠状动脉综合征或非ST段抬高型急性冠状动脉综合征患者
Single-Session Versus Staged Multivessel Optimal IVUS-Guided PCI in Patients With CCS or NSTE-ACS.
作者信息
Yamamoto Ko, Shiomi Hiroki, Morimoto Takeshi, Miyazawa Akiyoshi, Watanabe Hiroki, Nakamura Sunao, Suwa Satoru, Domei Takenori, Ono Koh, Sakamoto Hiroki, Shigetoshi Masataka, Taniguchi Ryoji, Okayama Hideki, Toyota Toshiaki, Yokomatsu Takafumi, Muto Masahiro, Kawaguchi Ren, Kishi Koichi, Hadase Mitsuyoshi, Fujita Tsutomu, Nishida Yasunori, Nishino Masami, Otake Hiromasa, Natsuaki Masahiro, Watanabe Hirotoshi, Suematsu Nobuhiro, Tanabe Kengo, Abe Mitsuru, Hibi Kiyoshi, Kadota Kazushige, Ando Kenji, Kimura Takeshi
机构信息
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
出版信息
JACC Asia. 2023 Jun 13;3(4):649-661. doi: 10.1016/j.jacasi.2023.03.013. eCollection 2023 Aug.
BACKGROUND
There are no studies comparing single-session vs staged multivessel intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with chronic coronary syndrome (CCS) or non-ST-segment-elevation acute coronary syndrome (NSTE-ACS).
OBJECTIVES
The authors aimed to compare single-session vs staged multivessel IVUS-guided PCI in patients with CCS or NSTE-ACS.
METHODS
The OPTIVUS-Complex PCI study multivessel cohort was a prospective multicenter single-arm trial enrolling 1,021 patients with CCS or NSTE-ACS undergoing multivessel PCI including left anterior descending coronary artery using IVUS aiming to meet the prespecified OPTIVUS criteria for optimal stent expansion. We compared single-session vs staged multivessel PCI. The primary endpoint was a composite of death, myocardial infarction, stroke, or any coronary revascularization.
RESULTS
There were 246 patients (24.1%) undergoing single-session multivessel PCI, and 775 patients (75.9%) undergoing staged multivessel PCI. There was a wide variation in the prevalence of single-session multivessel PCI across the participating centers. The staged multivessel PCI group more often had complex coronary anatomy such as 3-vessel disease, chronic total occlusion, and calcified lesions requiring an atherectomy device compared with the single-session multivessel PCI group. The rates of PCI success, procedural complications, and meeting OPTIVUS criteria were not different between groups. The cumulative 1-year incidence of the primary endpoint was not different between single-session and staged multivessel PCI groups (9.0% vs 10.8%, log-rank = 0.42). After adjusting confounders, the effect of single-session multivessel PCI relative to staged multivessel PCI was not significant for the primary endpoint (HR: 0.95; 95% CI: 0.58-1.55; = 0.84).
CONCLUSIONS
Single-session and staged multivessel IVUS-guided PCI had similar 1-year outcomes.
背景
尚无研究比较慢性冠状动脉综合征（CCS）或非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者单期与分期多支血管血管内超声（IVUS）引导下经皮冠状动脉介入治疗（PCI）的效果。
目的
作者旨在比较CCS或NSTE-ACS患者单期与分期多支血管IVUS引导下PCI的效果。
方法
OPTIVUS-Complex PCI研究的多支血管队列是一项前瞻性多中心单臂试验，纳入1021例接受多支血管PCI（包括使用IVUS的左前降支冠状动脉）的CCS或NSTE-ACS患者，旨在达到预设的OPTIVUS最佳支架扩张标准。我们比较了单期与分期多支血管PCI。主要终点是死亡、心肌梗死、卒中或任何冠状动脉血运重建的复合终点。
结果
246例患者（2�.1%）接受单期多支血管PCI，775例患者（75.9%）接受分期多支血管PCI。各参与中心单期多支血管PCI的患病率差异很大。与单期多支血管PCI组相比，分期多支血管PCI组更常出现复杂冠状动脉解剖结构，如三支血管病变、慢性完全闭塞和需要旋切装置的钙化病变。两组间PCI成功率、手术并发症及达到OPTIVUS标准的情况无差异。单期和分期多支血管PCI组主要终点的累积1年发生率无差异（9.0%对10.8%，对数秩检验=0.42）。调整混杂因素后，单期多支血管PCI相对于分期多支血管PCI对主要终点的影响不显著（HR：0.95；95%CI：0.58-1.55；P=0.84）。
结论
单期和分期多支血管IVUS引导下PCI的1年结局相似。
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