接受旋磨术的冠心病患者中，血管造影衍生的微循环阻力指数的预后价值
Prognostic Value of Angiography-Derived Index of Microcirculatory Resistance in Patients with Coronary Artery Disease Undergoing Rotational Atherectomy.
作者信息
Wang Bo, Gao Yue, Zhao Yifan, Jia Peng, Han Jun, Li Hailing, Zhang Yi, Xu Yawei
机构信息
Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072 Shanghai, China.
Department of Cardiology, North Station Hospital of Jing'an District, 200072 Shanghai, China.
出版信息
Rev Cardiovasc Med. 2023 Apr 27;24(5):131. doi: 10.31083/j.rcm2405131. eCollection 2023 May.
BACKGROUND
Rotational atherectomy (RA) is the major tool used to treat severely calcified lesions in patients with coronary artery disease (CAD). The relationship between coronary microvascular dysfunction and RA remains unknown. Therefore, we attempted to explore the predictive implications of the coronary angiography-derived index of microcirculatory resistance (angio-IMR) in CAD patients undergoing RA.
METHODS
This retrospective study included 118 patients with severe coronary calcification who underwent a successful RA from January 2018 to June 2021. The angio-IMR was calculated based on computed flow and pressure dynamic principles to assess coronary microcirculatory function. Follow-up was performed on all patients for major adverse cardiovascular events (MACEs), including all-cause death, non-fatal myocardial infarction, target vessel revascularization (TVR), and stroke.
RESULTS
The mean angio-IMR for all patients was 25.58 7.93. Patients were stratified the groups based on a mean angio-IMR of 25, fifty-four (45.8%) patients had angio-IMR 25. The logistic regression analysis showed that angiography-derived fractional flow reserve was significantly associated with coronary microvascular dysfunction. After median follow-up of 21.7 (15.1-24.0) months, MACEs occurred in 30.6%, including 12.5% all-cause deaths, 6.4% non-fatal myocardial infarction, 14.5% TVR, and 0.9% stroke. Kaplan-Meier analysis demonstrated that patients with angio-IMR 25 had greater cumulative MACEs (41.6%) and TVR (20.7%) than patients with preserved angio-IMR. COX regression analysis indicated that angio-IMR 25 and reduced left ventricular ejection fraction were independent predictors of MACEs. In addition, angio-IMR 25 and lowered minimum luminal area independently predicted TVR occurrence.
CONCLUSIONS
In CAD patients undergoing RA, angio-IMR 25 was an independent and significant predictor of MACEs and TVR.
CLINICAL TRIAL REGISTRATION
NCT05435898.
背景
旋磨术（RA）是治疗冠心病（CAD）患者严重钙化病变的主要工具。冠状动脉微血管功能障碍与RA之间的关系尚不清楚。因此，我们试图探讨冠状动脉造影衍生的微循环阻力指数（血管造影-IMR）对接受RA的CAD患者的预测意义。
方法
这项回顾性研究纳入了2018年1月至2021年6月期间118例成功接受RA的严重冠状动脉钙化患者。基于计算流量和压力动态原理计算血管造影-IMR，以评估冠状动脉微循环功能。对所有患者进行主要不良心血管事件（MACE）随访，包括全因死亡、非致命性心肌梗死、靶血管血运重建（TVR）和中风。
结果
所有患者的平均血管造影-IMR为25.58±7.93。根据平均血管造影-IMR为25对患者进行分组，54例（45.8%）患者的血管造影-IMR≤25。逻辑回归分析显示，血管造影衍生的血流储备分数与冠状动脉微血管功能障碍显著相关。在中位随访21.7（15.1-24.0）个月后，30.6%的患者发生MACE，包括12.5%的全因死亡、6.4%的非致命性心肌梗死、14.5%的TVR和0.9%的中风。Kaplan-Meier分析表明，血管造影-IMR≤25的患者累积MACE（41.6%）和TVR（20.7%）高于血管造影-IMR保留的患者。COX回归分析表明，血管造影-IMR≤25和左心室射血分数降低是MACE的独立预测因素。此外，血管造影-IMR≤25和最小管腔面积降低独立预测TVR的发生。
结论
在接受RA的CAD患者中，血管造影-IMR≤25是MACE和TVR的独立且显著的预测因素。
临床试验注册
NCT05435898。
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