冠状动脉造影与血管内超声显像在经冠状动脉介入术治疗冠状动脉粥样硬化性心脏病左主干病变中的效果比较

Comparison of coronary angiography and intravascular ultrasonography in the treatment of left main stem lesions of coronary atherosclerotic heart disease by transcoronary intervention

目的分析经冠状动脉介入术(PCI)治疗冠状动脉粥样硬化性心脏病(简称冠心病)左主干病变(LMCAD)中,冠状动脉造影(CAG)、血管内超声显像(IVUS)的应用效果。方法选择2021年2月至2022年4月收治的LMCAD患者120例,均进行PCI治疗,按照随机数字表法进行分组,CAG组患者60例,IVUS组60例,比较2种见冠状动脉处理方式的临床应用效果。结果术后3个月、6个月和12个月,CAG组的左心室射血分数(LVEF)为(56.2±1.4)%、(56.6±1.2)%、(54.6±1.2)%,左心室舒张末期内径(LVEDD)为(45.4±1.6)mm、(44.6±2.2)mm、(43.2±1.6)mm,IVUS组的LVEF为(57.3±2.2)%、(57.5±3.2)%、(55.6±2.2)%,LVEDD为(46.2±1.5)mm、(45.6±2.6)mm、(44.6±3.6)mm,IVUS组LVEF、LVEDD均明显高于CAG组(t=3.075、2.208、3.037,P=0.003、0.029、0.003;t=3.064、2.280、2.983,P=0.003、0.024、0.003);CAG、IVUS组相比,支架直径、支架长度、最小管腔直径、最小管腔面积、面积狭窄率、最小支架压力释放组间差异无统计学意义(P>0.05)。Kappa一致性分析,CAG组和IVUS组对各指标检测的一致性系数均在0.7以上,一致性良好。运动负荷、运动时间、ST压低幅度2组相比,IVUS组均较高(P<0.05);IVUS组的不良心脏事件发生率2%低于对照组的13%(χ^(2)=4.324,P=0.038)。结论在冠心病LMCAD患者行PCI治疗中,冠脉造影与血管内超声显像各有优势,可结合具体情况适当选择。

Objective To explore the application effects of coronary angiography(CAG)and intravascular ultrasound imaging(IVUS)in the treatment of left main coronary artery disease(LMCAD)through percutaneous coronary intervention(PCI).Methods One hundred and twenty LMCAD patients from February 2021 to April 2022 were selected,all of whom underwent PCI treatment.They were randomly divided into a CAG group of 60 patients and an IVUS group of 60 patients.The clinical application effects of the two different coronary management methods were compared.Results At 3,6,and 12 months after surgery,the left ventricular ejection fraction(LVEF)in the CAG group was(56.2±1.4)%,(56.6±1.2)%and(54.6±1.2)%,respectively.And the left ventricular end diastolic diameter(LVEDD)was(45.4±1.6)mm,(44.6±2.2)mm and(43.2±1.6)mm,respectively.The LVEF in the IVUS group was(57.3±2.2)%,(57.5±3.2)%and(55.6±2.2)%,with LVEDD of(46.2±1.5)mm,(45.6±2.6)mm and(44.6±3.6)mm.LVEF and LVEDD in the IVUS group were significantly higher than those in LVEF(LVEF compared with t=3.075,2.208,3.037,P=0.003,0.029,0.003;LVEDD compared with t=3.064,2.280,2.983,P=0.003,0.024,0.003).Compared with the CAG and IVUS groups,there was no difference in stent diameter,stent length,minimum lumen diameter,minimum lumen area,area stenosis rate,and minimum stent pressure release between the groups(P>0.05).Kappa consistency analysis showed that the consistency coefficients for each indicator detected in the CAG and IVUS groups were above 0.7,indicating good consistency.Compared with the two groups,the IVUS group had higher exercise load,exercise time,and ST depression amplitude(P<0.05).The incidence of adverse cardiac events in the IVUS group was 2%lower than 13%in the control group(t=4.324,P=0.038).Conclusion In patients with left main coronary artery disease undergoing PCI treatment,coronary angiography and intravascular ultrasound imaging have their own advantages,and can be appropriately selected based on specific circumstances.