Karamasis Grigoris V, Katsikis Athanasios, Konstantinou Klio, Clesham Gerald J, Kelly Paul A, Jagathesan Rohan, Prati Francesco, Bourantas Christos V, Davies John R, Keeble Thomas R
Cardiology Department, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK.
School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK.
J Clin Med. 2024 Aug 9;13(16):4667. doi: 10.3390/jcm13164667.
Use of intracoronary imaging (ICI) in cases of stent thrombosis (ST) is recommended and tailored treatment appears reasonable. Nevertheless, data supporting such a strategy are lacking. The aim of this study was to evaluate the clinical impact of ICI in the management of ST. The unadjusted study population was consecutive patients with definite ST presenting in a single tertiary cardiac centre and undergoing percutaneous coronary intervention (PCI). The presumed major mechanism of ST was assigned according to the real-time ICI interpretation by the PCI operator. Propensity score matching was performed with regard to ICI use to form the adjusted population and Kaplan-Meier analysis was applied to compare survival free of cardiac death (CD) or target lesion revascularization (TLR). The unadjusted population included 130 ST patients, with the majority presenting with ST-elevation myocardial infarction (STEMI) (88%) and very late ST (86%). ICI was performed in 45 patients, of whom optical coherence tomography (OCT) was performed in 30 cases. When the individual ST mechanisms were viewed as groups, there was an interaction observed between type of treatment (stent vs. non-stent) and ST mechanism, with non-stent treatment being more prevalent in cases of underexpansion, malapposition, in-stent restenosis and mechanism uncertainty. After application of matching, two groups of 30 patients were formed. ICI-guided management resulted in better survival free of CD-TLR at 2 years (93% vs. 73%, = 0.037). Intracoronary imaging guidance during PCI for ST had a direct impact on management (stent vs. non-stent) and resulted in a lower event rate at mid-term follow-up when propensity matched analysis was applied.
推荐在支架血栓形成（ST）病例中使用冠状动脉内成像（ICI），且采用针对性治疗似乎是合理的。然而，支持这一策略的数据尚缺乏。本研究的目的是评估ICI在ST管理中的临床影响。未经调整的研究人群为在单一三级心脏中心就诊并接受经皮冠状动脉介入治疗（PCI）的明确ST患者。ST的推测主要机制由PCI操作者根据实时ICI解读来确定。对ICI的使用进行倾向评分匹配以形成调整后的人群，并应用Kaplan-Meier分析比较无心脏死亡（CD）或靶病变血运重建（TLR）的生存率。未经调整的人群包括130例ST患者，大多数表现为ST段抬高型心肌梗死（STEMI）（88%）和极晚期ST（86%）。45例患者进行了ICI检查，其中30例进行了光学相干断层扫描（OCT）。当将个体ST机制视为分组时，观察到治疗类型（支架与非支架）和ST机制之间存在相互作用，在扩张不足、贴壁不良、支架内再狭窄和机制不确定的病例中，非支架治疗更为普遍。匹配后，形成了两组各30例患者。ICI指导的管理在2年时导致无CD-TLR的生存率更高（93%对73%，P = 0.037）。在PCI治疗ST期间，冠状动脉内成像指导对管理（支架与非支架）有直接影响，并且在应用倾向匹配分析时，中期随访时事件发生率更低。
