光学相干断层成像引导经皮冠状动脉介入治疗药物洗脱支架内再狭窄的临床意义：对患者结局的影响。
Clinical Significance of Optical Coherence Tomography-Guided Percutaneous Coronary Intervention for In-Stent Restenosis Within Drug-Eluting Stents: Impact on Patient Outcomes.
机构信息
Medical School of Chinese PLA Beijing China.
Senior Department of Cardiology Sixth Medical Center of Chinese PLA General Hospital Beijing China.
出版信息
J Am Heart Assoc. 2024 Nov 5;13(21):e033954. doi: 10.1161/JAHA.123.033954. Epub 2024 Nov 4.
BACKGROUND
The evidence for optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) in improving the prognosis of individuals with in-stent restenosis (ISR) is lacking.
METHODS AND RESULTS
This retrospective study enrolled 588 consecutive individuals with drug-eluting stent ISR undergoing PCI from March 2010 to March 2022. Two hundred seven (35.2%) underwent OCT guidance, and 381 (64.8%) underwent angiography guidance. Clinical outcomes were analyzed using survival curves. The primary clinical endpoint was 2-year major adverse cardiovascular events (MACEs), a composite of all-cause death, myocardial infarction, and target-vessel revascularization. Compared with angiography guidance, OCT guidance demonstrated a higher frequency of drug-coated balloon use and adjunctive therapeutic modalities, including predilation, postdilation, nonslip element balloons, and noncompliant balloons (<0.05). Following PCI, the OCT-guided group achieved a significantly larger minimum lumen diameter (2.36 versus 2.15 mm, <0.001) and a lower percentage diameter stenosis (17% versus 20%, <0.001) than the angiography-guided group. Survival analysis revealed significantly lower 2-year MACEs in the OCT-guided group compared with the angiography-guided group (7% versus 15%, =0.007), validated in the propensity matching analysis (7% versus 15%, =0.001). Multiple sensitivity analyses showed that OCT-guided PCI treatment was an independent protective factor for 2-year MACEs in individuals with drug-eluting stent ISR.
CONCLUSIONS
Compared with angiography guidance, OCT guidance is associated with a lower 2-year MACE risk among individuals with drug-eluting stent ISR. Therefore, OCT should be actively considered for guiding PCI treatment in individuals with drug-eluting stent ISR.
REGISTRATION
Url: clinicaltrials.gov. Identifier: NCT03809754.
背景
光学相干断层扫描（OCT）指导下的经皮冠状动脉介入治疗（PCI）在改善支架内再狭窄（ISR）患者预后方面的证据不足。
方法和结果
本回顾性研究纳入了 2010 年 3 月至 2022 年 3 月期间接受 PCI 治疗的 588 例药物洗脱支架 ISR 连续患者。其中 207 例（35.2%）接受了 OCT 指导，381 例（64.8%）接受了血管造影指导。使用生存曲线分析临床结局。主要临床终点为 2 年主要不良心血管事件（MACE），包括全因死亡、心肌梗死和靶血管血运重建的复合终点。与血管造影指导相比，OCT 指导下药物涂层球囊使用率和辅助治疗方式（包括预扩张、后扩张、非滑元件球囊和顺应性球囊）更高（<0.05）。PCI 后，OCT 指导组的最小管腔直径明显大于血管造影指导组（2.36 毫米对 2.15 毫米，<0.001），直径狭窄率明显低于血管造影指导组（17%对 20%，<0.001）。生存分析显示，OCT 指导组 2 年 MACE 发生率明显低于血管造影指导组（7%对 15%，=0.007），在倾向评分匹配分析中也得到验证（7%对 15%，=0.001）。多项敏感性分析显示，OCT 指导下的 PCI 治疗是药物洗脱支架 ISR 患者 2 年 MACE 的独立保护因素。
结论
与血管造影指导相比，OCT 指导与药物洗脱支架 ISR 患者 2 年 MACE 风险降低相关。因此，OCT 应积极考虑用于指导药物洗脱支架 ISR 患者的 PCI 治疗。
注册
网址：clinicaltrials.gov。标识符：NCT03809754。
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