血管内超声探测的衰减斑块对经皮冠状动脉介入治疗患者术中及术后的影响:12个月临床随访结果

One year follow-up of attenuated plaques detected by IVUS during percutaneous coronary intervention

目的对急性心肌梗死(AMI)患者行血管内超声(IVUS)检查探测衰减斑块,观察及探讨衰减斑块患者行经皮冠状动脉介入治疗(PCI)术中情况及术后12个月临床随访结果。方法纳入2012年12月至2014年4月北京安贞医院急诊危重症中心收治的急性心肌梗死患者85例,行冠状动脉造影并进行IVUS检查,必要时行PCI术。根据IVUS是否探测到衰减斑块将患者分为衰减斑块组和非衰减斑块组,比较两组患者围术期IVUS影像学结果。球囊扩张术后TIMI血流情况及术后12个月主要不良心脑血管事件(MACCE)发生率。结果 85例AMI患者IVUS检测结果分为衰减斑块组35例(41.2%),非衰减斑块组50例(58.8%)。两组患者年龄、性别、合并糖尿病、合并高血压病、低密度脂蛋白胆固醇等方面比较,差异均无统计学意义(均P>0.05);衰减斑块组患者脑钠肽显著低于非衰减斑块组[(55.92±10.27)pg/ml比(60.32±9.22)pg/ml,P=0.029],差异有统计学意义。两组患者术前TIMI血流分级比较,差异均无统计学意义(P>0.05);但在球囊扩张术后,衰减斑块组患者TIMI血流0~Ⅱ级比例(37.1%比10.0%,P=0.003)显著高于非衰减斑块组,差异有统计学意义。IVUS探测下衰减斑块组患者病变血管截面积[(15.48±3.22)mm^2比(11.71±3.01)mm^2,P<0.001]、斑块面积[(14.40±4.11)mm^2比(10.69±2.85)mm^2,P<0.001]、斑块负荷[(87.42±3.83)mm^2比(80.14±4.18)mm^2,P<0.001]、参考血管截面积[(14.18±3.12)mm^2比(11.22±2.89)mm^2,P<0.001]、偏心性(68.6%比36.0%,P<0.001)显著大于非衰减斑块组,差异均有统计学意义。术后随访12个月,两组患者总MACCE发生率比较,差异无统计学意义(P>0.05)。结论在IVUS探测下发现的衰减斑块,可导致球囊扩张术后无复流及慢血流发生率的增加。

Objective Detect attenuated plaque by intravascular ultrasound in patents with acute myocardial infarction and investigate the influence of attenuated plaque on peri-PCI period and one year follow-up. Methods 85 patients hospitalized for acute myocardial infarction（ 28 cases with STEMI,57 cases with NSTEMI） were included. The 85 patients accepted coronary angiography, intravascular ultrasound,and stent implantation as needed. Patients were divided into attenuated plaque group or nonattenuated plaque group according to the intravascular ultrasound finding. The imaging characteristics,TIMI flow and incidence of major adverse cardiovascular and cerebrovascular（ MACCE） events were compared between the two groups. Results 85 patients were diagnosed as AMI,35 patients detected with attenuated plaque（ 41. 2%） and 50 patients（ 58. 8%） without attenuated plaque. There were no statistical differences between the two groups in age,sex and other CAD risk factors. More patients admitted for STEMI had attenuated plaque than patients with NSTEMI（ P = 0. 002）. No significant difference was found in coronary angiography for TIMI flow between groups with or without attenuated plaque. TIMI flow 0-2 grades were more often in patients with attenuated plaque than without attenuated plaque after angioplasty（ P = 0. 003）. In attenuated plaque group,plaque burden,eccentric property,vessel sectional area at lesion sites and referential vessel sectional area detected by IVUS were significantly greater than non-attenuated plaque group（ P〈0. 001）. There was no difference in MACCE between the two groups（ P = 0. 82） in 1-year follow up.Conclusions Attenuated plaque detected more frequently in STEMI patients tends to cause no-reflow and slow reflow phenomenon after PCI therapy.