血管内超声评价冠脉钙化长度比对介入治疗的影响

Effect of coronary calcification length on percutaneous coronary intervention:An intravascular ultrasound study

目的探讨不同程度冠脉钙化病变对经皮冠脉介入治疗(percutaneous coronary intervention,PCI)疗效的影响。方法连续收集我中心2012年7月-2013年1月71例冠心病患者(71处靶病变),利用血管内超声分析冠脉斑块特征、评估支架植入情况。观察钙化组与非钙化组介入操作特征、即刻疗效和院内主要不良心脏事件(major adverse cardiac events,MACE)。在钙化弧度≤180°和>180°的病变中,对比钙化长度比>0.5与钙化长度比<0.5介入治疗即刻疗效。结果 71处靶病变中43处钙化病变,28处非钙化病变。钙化组术后最小支架直径、最小支架横截面积明显小于非钙化组,预扩比例明显增高(P<0.05),支架膨胀指数亦小于非钙化组,但无统计学差异。在钙化弧度≤180°病变中,长钙化组支架膨胀指数明显低于短钙化组(P<0.05)。在钙化弧度>180°的病变中,长钙化组钙化弧度明显大于短钙化组,且支架膨胀指数倾向于小于短钙化组。所有患者均无院内MACE发生。结论冠脉钙化病变影响了支架的充分扩张;钙化弧度≤180°时,如钙化长度比>0.5,则支架的扩张明显受限;钙化弧度>180°时,长钙化病变往往伴随着大弧度钙化,其支架膨胀效果欠佳。

Objective To study the effect of different coronary calcification lengths on percutaneous coronary intervention （PCI）. Methods Seventy-one patients （71 target lesions） with coronary heart disease （CHD） admitted to our center from July 2012 to January 2013 were divided into calcification group and non- calcification group. Their coronary artery plaques and stenting were assessed and analyzed by intravascular ultrasonography. The characteristics, immediate outcome and major adverse cardiac events （MACE） of PCI between the two groups were observed. The immediate outcomes of PCI were compared when the ratio of calcification length 〉 0.5 or 〈 0.5 in the lesions with their calcification arc ≤180° or 〉 180°. Results Of the 71 target lesions, 43 were calcified and 28 were not calcified. The minimal stent diameter was shorter and the minimal stent cross-section area （CSA） was smaller in calcification group than in non-calcification group （P 〈 0.05）. The pre-expanded stent ratio was lower in calcification group than in non-calcification group （P 〈 0.05）. The stent expansion index in the lesions with their calcification arc ≤ 180° was significantly lower while the stent expansion index in the lesions with their calcification arc 〉 180° was significantly higher in calcification group than in non-calcification group （P 〈 0.05）. No MACE occurred in all patients. Conclusion Coronary artery calcification affects the full stent expansion. The stent expansion is obviously restricted in lesions with their calcification length ratio 〉 0.5 when the calcification arc is ≤ 180° and is limited with the calcification when the calcification arc is 〉 180°.