Li Jiannan, Wang Xiaoli, Chen Runzhen, Zhou Peng, Liu Chen, Song Li, Chen Yi, Yan Hongbing, Zhao Hanjun
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, 100037 Beijing, China.
Department of Cardiology, Dongguan Cardiovascular Research Institute, Dongguan Songshan Lake Central Hospital, Guangdong Medical University, 523770 Dongguan, Guangdong, China.
Rev Cardiovasc Med. 2024 Dec 18;25(12):444. doi: 10.31083/j.rcm2512444. eCollection 2024 Dec.
Despite the administration of timely reperfusion treatment, patients with acute myocardial infarction have a high mortality rate and poor prognosis. The potential impact of intraluminal imaging guidance, such as optical coherence tomography (OCT), on improving patient outcomes has yet to be conclusively studied. Therefore, we conducted a retrospective cohort study to compare OCT-guided primary percutaneous coronary intervention (PCI) versus angiography-guided for patients with ST-segment elevation myocardial infarction (STEMI).
This study enrolled 1396 patients with STEMI who underwent PCI, including 553 patients who underwent OCT-guided PCI and 843 patients who underwent angiography-guided PCI. The clinical outcome was a composite of cardiovascular death, myocardial infarction, admission due to heart failure, stroke, and unplanned revascularization at the 4-year follow-up.
The prevalence of major adverse cardiovascular events in OCT-guided group was not significantly lower compared to those without OCT guidance after adjustment (unadjusted hazard ratio (HR), 1.582; 95% confidence interval (CI), 1.300-1.924; < 0.001; adjusted HR, 1.095; adjusted 95% CI, 0.883-1.358; = 0.409). The prevalence of cardiovascular death was significantly lower in patients with OCT guidance compared to those without before and after adjustment (unadjusted HR, 3.303; 95% CI, 2.142-5.093; < 0.001; adjusted HR, 2.025; adjusted 95% CI, 1.225-3.136; = 0.004).
OCT-guided primary PCI used to treat STEMI was associated with reduced long-term cardiovascular death.
尽管进行了及时的再灌注治疗，但急性心肌梗死患者的死亡率仍然很高，预后较差。腔内成像指导（如光学相干断层扫描（OCT））对改善患者预后的潜在影响尚未得到确凿研究。因此，我们进行了一项回顾性队列研究，比较OCT指导下的直接经皮冠状动脉介入治疗（PCI）与血管造影指导下的ST段抬高型心肌梗死（STEMI）患者的疗效。
本研究纳入了1396例行PCI的STEMI患者，其中553例接受了OCT指导下的PCI，843例接受了血管造影指导下的PCI。临床结局是4年随访时心血管死亡、心肌梗死、因心力衰竭入院、中风和非计划血管重建的综合结果。
调整后，OCT指导组主要不良心血管事件的发生率与未接受OCT指导的组相比无显著降低（未调整风险比（HR），1.582；95%置信区间（CI），1.300-1.924；<0.001；调整后HR，1.095；调整后95%CI，0.883-1.358；=0.409）。调整前后，接受OCT指导的患者心血管死亡发生率显著低于未接受OCT指导的患者（未调整HR，3.303；95%CI，2.142-5.093；<0.001；调整后HR，2.025；调整后95%CI，1.225-3.136；=0.004）。
用于治疗STEMI的OCT指导下的直接PCI与长期心血管死亡风险降低相关。
