OCT联合冠状动脉造影指导与单纯冠状动脉造影指导对STEMI患者介入治疗临床结果影响

Clinical analysis of optical coherence tomography plus coronary angiography guided and alone coronary angiography guided primary percutaneous coronary intervention in patients with ST-segment elevation myocardial

目的探讨光学相干断层成像技术(OCT)联合冠脉造影指导下对急性ST段抬高心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)的临床疗效。方法入选2016年1月至2017年5月于首都医科大学附属北京潞河医院和2019年1月至6月于首都医科大学附属北京友谊医院住院的急性STEMI患者。OCT组选择接受急诊PCI并行OCT检查的STEMI患者100例,应用OCT检查明确心肌梗死(心梗)病因,决定介入方案,在OCT指导下行介入治疗;冠脉造影组患者选择在同期内未行OCT的行急诊PCI的STEMI患者,按照梗死相关冠状动脉(冠脉)相同、性别相同、年龄相差±5岁的条件,两组按照1:1进行匹配。主要观察终点是术后30 d主要心脏不良事件(MACE)发生率;次要观察终点包括支架和球囊选择是否存在差异及术后冠脉TIMI分级、心功能和生化指标的差异。结果本研究OCT发现STEMI患者斑块破裂、斑块侵蚀、钙化结节发生率分别为54%、22%、2%、2%。OCT组共用球囊184个,植入药物洗脱支架113枚,冠脉造影组共用球囊186个,共置入支架122枚,两组均无统计学差异(P>0.05)。两组术后TIMI血流、肌酸激酶同工酶(CKMB)峰值、左室射血分数均无明显差异(P>0.05)。两组术后30 d MACE事件发生率两组无差异(P>0.05)。OCT发现支架术后即刻支架贴壁不良率、支架边缘夹层、组织脱垂、支架膨胀不全发生率分别为23%、16%、18%、1%。结论斑块破裂是STEMI的主要发病原因,其次是斑块侵蚀,OCT指导的介入治疗可以明确STEMI的发病机制及时发现介入并发症,指导临床处理,未增加MACE事件。

Objective To investigate the clinical efficacy of optical coherence tomography(OCT)combined with coronary angiography in emergency percutaneous coronary intervention(PCI)for acute ST-segment elevation myocardial infarction(STEMI).Methods Patients with acute STEMI hospitalized in Beijing Luhe Hospital affiliated to Capital Medical University from January 2016 to May 2017 and Beijing Friendship Hospital affiliated to Capital Medical University from January to June 2019 were enrolled.In the OCT group,100 STEMI patients who underwent emergency PCI and OCT examination were selected.OCT examination was used to determine the cause of myocardial infarction,determine the intervention plan,and perform interventional treatment under the guidance of OCT.In the coronary angiography group,100 STEMI patients who underwent emergency PCI without OCT in the same period were selected according to the conditions of the same infarction-related coronary artery,the same sex,and the age difference between±5 years.And the two groups were matched 1:1.The primary endpoint was the incidence of major adverse cardiac events(MACE)30 days after surgery.The secondary endpoints included differences in stent and balloon selection,and changes in coronary TIMI grade,cardiac function,and biochemical parameters after surgery.Results OCT in this study found that the incidence of plaque rupture,plaque erosion and calcified nodules in STEMI patients were 54%,22%,2%and 2%,respectively.There were 184 balloons in the OCT group,113 drug-eluting stents in total.There were 186 balloons in the coronary angiography group,and 122 stents in total.There was no significant difference between the two groups(P>0.05).There were no significant differences in TIMI blood flow,peak CKMB and left ventricular ejection fraction between the two groups(P>0.05).There was no difference between the two groups in the incidence of MACE events in 30 days after operation(P>0.05).The incidence of stent malapposition,edge dissection,tissue prolapse,and stent insufficiency was 23%,16%,18%,and 1%,respectively,in the immediate post-stent period by OCT.Conclusion Plaque rupture is the main cause of STEMI,followed by plaque erosion.OCT-guided interventional therapy can clarify the pathogenesis of STEMI,timely detect interventional complications and guide clinical management without increasing MACE events.