血管内超声指导下介入治疗左主干病变的效果及对远期预后的影响

Efficacy and long-term prognosis of intervention guided by intravascular ultrasound in the treatment of left main coronary artery disease

目的探讨血管内超声指导下经皮冠状动脉介入术(PCI)治疗左主干病变的临床效果及对远期预后的影响。方法抽取2018年9月至2021年3月焦作煤业(集团)有限责任公司中央医院收治的左主干病变患者50例,据双色球法分为对照组和观察组,每组25例。对照组在冠状动脉造影指导下行PCI,观察组在血管内超声指导下行PCI。比较两组PCI指标、并发症发生情况、支架置入达标率,比较两组随访半年、1年时的左心室舒张末期内径(LVEDD)及术后1年内心脏不良事件发生率。结果观察组支架直径、支架长度大于对照组,后扩张次数、后扩张球囊直径、后扩张球囊压力小于对照组,差异有统计学意义(P<0.05)。观察组PCI并发症发生率(4.00%,1/25)低于对照组(28.00%,7/25),支架置入达标率(100.00%,25/25)高于对照组(80.00%,20/25),随访半年、1年时LVEDD低于对照组,差异有统计学意义(P<0.05)。观察组术后1年内心脏不良事件发生率(8.00%,2/25)低于对照组(40.00%,10/25),P<0.05。结论左主干病变在血管内超声指导下行PCI相比于冠状动脉造影指导下PCI,可更好地避免PCI并发症的发生,提高支架置入达标率,同时减少远期心脏不良事件发生。

Objective To investigate the clinical efficacy of percutaneous coronary intervention(PCI)guided by intravascular ultrasound in the treatment of left main coronary artery disease,and its influence on long-term prognosis.Methods A total of 50 patients with left main coronary artery disease admitted to Central Hospital of Jiaozuo Coal Industry(Group)Co.,Ltd from September 2018 to March 2021 were selected,and they were divided into control group and observation group by dichromatic sphere method,with 25 cases in each group.The control group was treated by PCI guided by coronary angiography,and the observation group was treated by PCI guided by intravascular ultrasound.The PCI indicators,incidence of complications,and success rate of stent placement were compared between two groups.The left ventricular end-diastolic diameter(LVEDD)during 6 months and 1 year of follow-up,and the incidence of adverse cardiac events within 1 year after surgery were compared between the two groups.Results The diameter and length of the stent in the observation group were longer than those in the control group,while the number of subsequent expansions,diameter of the posterior dilated balloon,and pressure of the posterior dilated balloon in the observation group were lower than those in the control group,with statistically significant differences(P<0.05).The incidence of PCI complications in the observation group(4.00%,1/25)was lower than that in the control group(28.00%,7/25),while the success rate of stent placement(100.00%,25/25)was higher than that in the control group(80.00%,20/25),and the LVEDD was lower than that in the control group during 0.5 and 1 year of follow-up(P<0.05).The incidence of adverse cardiac events within 1 year after surgery in the observation group(8.00%,2/25)was lower than that in the control group(40.00%,10/25),P<0.05.Conclusions Compared with PCI guided by coronary angiography,PCI guided by intravascular ultrasound in the treatment of left main coronary artery disease can better avoid PCI complications,improve the success rate of stent placement,and reduce long-term adverse cardiac events.