血管内超声引导下行冠状动脉旋磨术对患者预后的影响

Influence of intravascular ultrasound on the prognosis of patients after rotational atherectomy

目的新型血管内影像技术的发展优化了手术治疗策略。文中探讨血管内超声(IVUS)引导下进行冠状动脉旋磨手术对术后远期随访事件的影响。方法回顾性分析2011年11月至2018年12月在南京鼓楼医院心内科211例行冠状动脉内旋磨(RA)手术患者临床资料,并根据是否进行血管内超声引导分为IVUS引导组(116例)和非IVUS引导组(95例)。收集所有患者的基础信息、冠脉病变情况及手术操作细节等临床资料。通过电话或门诊随访方式收集并比较患者术后远期预后情况。结果IVUS引导组患者旋磨头直径、平均支架直径、住院总费用均显著大于非IVUS引导组,差异均有统计学意义[(1.53±0.19)mm vs(1.46±0.14)mm,P=0.001;(3.09±0.48)mm vs(2.87±0.30)mm,P<0.001;(5.73±1.83)万元vs(4.93±1.66)万元,P=0.001];全因病死率及心源性病死率均低于非IVUS引导组(7.5%vs 16.7%,P=0.048;1.9%vs 11.9%,P=0.005);远期主要心血管不良事件、心肌梗死、靶血管血运重建和非致死性脑卒中发生率组间差异无统计学意义(P>0.05)。多因素COX回归分析结果显示,IVUS引导组心源性死亡率显著降低(HR=0.10,95%CI:0.02~0.63,P=0.014),而全因死亡及远期MACE事件发生率两组差异并无统计学意义(P>0.05)。结论相比于非IVUS引导组,IVUS引导下的旋磨手术可显著减少远期心源性死亡的发生率,且降低住院总费用。

Objective The development of new endovascular imaging techniques has optimized surgical treatment strategies.In this paper,we investigated the effect of rotational atherectomy(RA)guided by intravascular ultrasound(IVUS)on long⁃term post⁃operative follow⁃ups.Methods Clinical data of 211 patients who underwent RA in the Department of Cardiology,Nanjing Drum Tower Hospital from November 2011 to December 2018 were retrospectively analyzed,and they were divided into IVUS Group(116 pa⁃tients)and Non⁃IVUS Group(95 patients)according to whether they underwent the guidance of intravascular ultrasound or not.Basic information of all patients,coronary artery lesions and details of operation and other clinical data were collected.The long⁃term progno⁃sis of the patients was collected and compared by telephone or outpatient follow⁃ups.Results The head diameter,average stent diameter and total hospitalization expenses of the IVUS Group were significantly higher than those of the Non⁃IVUS Group,and the differ⁃ences were statistically significant[(1.53±0.19)mm vs(1.46±0.14)mm,P=0.001;(3.09±0.48)mm vs(2.87±0.30)mm,P<0.001;(57,300±18,300)yuan vs(49,300±16,600)yuan,P=0.001].The all⁃cause case fatality rate and cardiogenic case fatality rate of the IVUS Group were lower than those of the Non⁃IVUS Group(7.5%vs 16.7%,P=0.048;1.9%vs 11.9%,P=0.005);There were no significant differences in the incidence of long⁃term major adverse cardiovascular events(MACE),myocardial infarc⁃tion,target vessel revascularization and non⁃fatal stroke between the two groups(P>0.05).Multivariate COX regression analysis showed that the cardiogenic mortality was significantly reduced in the IVUS Group(HR=0.10,95%CI:0.02~0.63,P=0.014),but there was no statistically significant difference between the two groups in the incidence of all⁃cause death and long⁃term MACE(P>0.05).Conclusion Compared with the Non⁃IVUS Group,IVUS⁃guided RA can significantly reduce the incidence of long⁃term car⁃diogenic death and total hospitalization expenses.