血管内超声PCI中碘造影剂使用的对照研究

Control Study on Intravascular Ultrasound Guidance on the Use of Iodine Contrast in Percutaneous Coronary Intervention

目的评估血管内超声(Intravascular Ultrasound Imaging,IVUS)引导对接受经皮冠状动脉介入治疗(Percutaneous Coronary Intervention,PCI)的患者最终使用造影剂剂量的影响。方法将83名患者随机分配成两组:血管造影引导的PCI组和IVUS引导的PCI组,评价指标是患者在PCI期间4个月内平均使用的碘对比剂总体积。结果在血管造影引导组中,碘对比造影剂使用量的中值与血管超声引导组分别为64.5 m L和20.0 m L(P<0.001)。同时,在用IVUS引导的PCI治疗的患者中,对比剂/肌酐清除率的值平均值显著降低(P<0.001)。随机分配的血管造影引导组和IVUS引导的PCI的患者在住院期间和4个月的结果并没有显著差异。结论 IVUS是应用于PCI的安全且有效的成像工具,并且与血管造影引导相比,显著地减少了碘对比剂的使用。对于可能因碘对比剂诱发的急性肾损伤或超负荷的高风险患者,应考虑使用IVUS。

Objective To evaluate the impact of intravascular ultrasound imaging(IVUS)guidance on the final volume of contrast agent utilized in patients undergoing percutaneous coronary intervention(PCI).Methods A total of83patients were randomized grouped to angiography-guided PCI group and IVUS-guided PCI group.The primary endpoint was the total volume contrast agent used during PCI.Patients were followed clinically for an average of4months.Results The median total volume of contrast was64.5mL in angiography-guided group vs.20.0mL in IVUS-guided group(P<0.001).Similarly,the median volume of contrast/creatinine clearance ratio was significantly lower than patients who were treated with IVUS-guided PCI(P<0.001).The in-hospital and4-month outcomes were not different between the two groups.Conclusion The tilization of IVUS as the primary imaging tool is safe to guide PCI,and markedly reduces the volume of iodine contrast,compared to angiography-alone guidance.The use of IVUS should be considered for patients at high risk for contrast-induced acute kidney injury or volume overload undergoing coronary angioplasty.