CAG与OCT评价DCB行PCI时的冠状动脉管腔变化的差异

Difference between CAG and OCT in evaluating the changes of coronary lumen during PCI with DCB

目的:探索冠状动脉(冠脉)原位病变预处理成功的光学相干断层成像技术(OCT)标准及OCT在冠脉原位病变精准介入中的临床价值。方法:选取2020年9月-2021年7月上海交通大学医学院附属第九人民医院冠脉造影(CAG)后需要血运重建,适合行经皮冠脉介入且倾向非植入,并同意行OCT检查的冠心病患者,共30例(31处病变)。在应用控制性球囊成形术作为预处理手段前后,及行药物涂层球囊或药物洗脱支架植入后分别行OCT检查,将OCT与CAG的检查数据及指导的治疗决策进行对比,观察术中预处理成功率及OCT指导的治疗决策转变。结果:按照CAG标准,有28处(90.3%)病变预处理成功;3处(9.7%)病变预处理失败,其中1处病变出现弹性回缩,2处病变出现C型夹层。按照OCT标准,有15处(48.4%)病变预处理成功;16处(52.6%)病变因出现预处理后发生的夹层预处理失败。两种预处理成功标准的治疗策略有统计学差异(P<0.001)。OCT指导的残余狭窄最小管腔参考直径比CAG指导的残余狭窄最小管腔参考直径更大,且有统计学差异[(2.93±0.07) mm∶(2.77±0.26) mm,P<0.001]。结论:OCT在指导冠脉原位病变介入治疗时更加精准明确客观,具有较高的临床应用价值。

Objective: To explore the criteria of optical coherence tomography for the successful pretreatment of coronary artery in situ lesion and observe the clinical value of optical coherence tomography in the precise intervention of coronary in situ lesions. Methods: From September, 2020 to July, 2021, 30 patients with coronary heart disease(except for acute ST segment elevation myocardial infarction within 1 month) who needed revascularization after coronary angiography and suitable for coronary intervention(PCI) and predisposed to non-implantation therapy and agreed to accept OCT examination were selected in the Department of Cardiology of Ninth People’s Hospital of School of Medicine of Shanghai Jiaotong University. OCT was performed before and after pretreatment, and after drug-coated balloon or drug-eluting stent implantation. The data and treatment decision guided by OCT and coronary angiography were compared. And then we observed the success rate of pretreatment and the change of treatment decision guided by OCT. Results: Among the 30 patients and 31 lesions, according to the criteria of coronary arteriography, 28(90.3%) lesions were pretreated successfully, and 3 Lesions failed to be pretreated, in which one(3.2%) lesion showed elastic retraction, and 2 lesions(6.5%) showed type C dissection. According to the criteria of OCT, 15(48.4%) lesions were pretreated successfully, and 16(52.6%) lesions failed to be pretreated due to dissection appeared after pretreatment. There was a significant difference in treatment decision-making between the two pretreatment success criteria(P<0.001). The Minimum reference diameter of residual stenosis guided by OCT was larger than that guided by coronary angiography(2.93 ± 0.07 mm vs. 2.77 ± 0.26 mm, P=0.002). Conclusion: OCT is more accurate, definite, objective and has higher clinical value than coronary angiography in guiding PCI.