利用光学相干断层成像探讨急性冠状动脉综合征患者病变血管中胆固醇结晶与1年预后的相关性:一项回顾性研究

The relationship between cholesterol crystals and 12-month prognosis in patients with acute coronary syndromes undergoing optical coherence tomography-guided percutaneous coronary intervention:a retrospective study

目的本研究旨在探讨在接受光学相干断层成像(optical coherence tomography,OCT)引导下经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的急性冠状动脉综合征(acute coronary syndromes,ACS)患者中,胆固醇结晶(cholesterol crystals,CCs)与12个月预后之间的关系。研究对象回顾性分析2020年7月至2022年6月在武汉大学人民医院行OCT引导PCI的ACS患者403例,年龄中位数为62.0岁,其中男性患者为320例。干预措施本研究为回顾性研究,根据管壁内有无CCs分为Non-CCs组和CCs组两组。中位随访时间19.7个月。观测指标及测量方法数据收集包括人口统计学信息、临床特征、病史、实验室结果和出院后用药情况。分析靶血管PCI术前的OCT成像特征。评估Non-CCs组和CCs组预后的差异,主要结局指标为全因死亡、缺血驱动血运重建及因心力衰竭再入院发生率。结果本研究共纳入403例ACS患者,其中有224个(55.6%)靶病灶出现CCs。与Non-CCs组患者相比,CCs组患者1年复合预后较差的风险更高[17.0%vs.6.7%,风险比(hazard ratio,HR):2.71;95%置信区间(confidence interval,CI):1.41~5.18,P=0.003],对于具体结局分析,主要表现为非靶血管重建(9.8%vs.2.8%,HR:3.63;95%CI:1.38~9.57,P=0.009)。包括多变量Cox回归和逆概率加权(inverse probability of treatment weighting,IPTW)分析在内的多种敏感性分析一致表明,靶血管内CCs沉积患者的临床结果更差。结论接受OCT引导的PCI患者,CCs的存在可能与ACS患者1年的预后不良具有相关性。

Objective This study aimed to investigate the relationship between cholesterol crystals(CCs)and 12-month prognosis in patients with acute coronary syndromes(ACS)undergoing percutaneous coronary intervention(PCI)guided by optical coherence tomography(OCT).Subjects A retrospective analysis was conducted on 403 ACS patients who underwent OCT-guided PCI at Renmin Hospital of Wuhan University from July 2020 to June 2022,with a median age of 62.0 years,including 320 male patients.Interventions Patients were categorized into two groups based on the presence or absence of CCs within the vessel wall,termed as the Non-CCs group and CCs group,respectively.The median follow-up duration was 19.7 months.Main Outcomes and Measurements Data collection included demographic information,clinical features,medical history,laboratory results,and post-discharge medication usage.OCT imaging features of target vessel PCI were analyzed.The differences in prognosis between the Non-CCs group and CCs group were evaluated,with primary outcome measures including all-cause mortality,ischemia-driven revascularization,and hospital readmission due to heart failure.Results Among the 403 ACS patients included in the study,224(55.6%)had CCs at the target lesions.Compared to patients in the Non-CCs group,those in the CCs group had a higher risk of poor composite prognosis at one year(17.0%vs.6.7%,hazard ratio[HR]:2.71;95%confidence interval[CI]:1.41-5.18,P=0.003).Notably,there was a noticeable increase in non-target vessel revascularization after one year in patients with CCs(9.8%vs.2.8%,HR:3.63;95%CI:1.38-9.57,P=0.009),according to individual outcome components analysis.Multiple sensitivity analyses,including multivariate Cox regression and inverse probability of treatment weighted(IPTW)analysis,consistently Conclusion indicated worse clinical outcomes in patients with CCs deposition within the target vessel.The presence of CCs in patients undergoing OCT-guided PCI may be associated with adverse prognosis in ACS patients at one year.