冠状动脉内光学相干断层成像特征与稳定型冠心病患者PCI术后支架内再狭窄风险的相关性

Correlation between optical coherence tomography characteristics in coronary artery and risk of in-stent restenosis in patients with stable coronary heart disease after percutaneous coronary intervention

目的探讨冠状动脉内光学相干断层成像(OCT)特征与稳定型冠心病患者经皮冠状动脉介入(PCI)术后支架内再狭窄(ISR)风险的相关性。方法回顾性纳入2021年8月至2023年12月于青岛心血管病医院行PCI术治疗并完成1年随访的100例稳定型冠心病患者作为研究对象,根据PCI术后1年内是否出现ISR分为ISR组(50例)和无ISR组(50例)。对比两组患者临床资料、冠状动脉内OCT特征等,采用多因素Logistic回归系数分析PCI术后ISR的影响因素,通过绘制ROC曲线进一步分析影响因素对PCI术后ISR的预测效能。结果ISR组他汀类药物用量低于无ISR组,总胆固醇及低密度脂蛋白胆固醇(LDL-C)高于无ISR组,最小管腔内径(MLD)小于无ISR组(t=11.596、5.562、8.498、10.185,P<0.05)。ISR组管腔面积、新生内膜负荷高于无ISR组,异质性内膜、脂质斑块和钙化占比高于无ISR组(t/χ^(2)=10.248、3.581、9.180、5.769、7.440,P<0.05)。多因素Logistic回归分析显示:他汀类药物用量是稳定型冠心病患者PCI术后ISR的保护因素(OR=0.612,P<0.05),LDL-C、新生内膜负荷、异质性内膜和钙化是稳定型冠心病患者PCI术后ISR的危险因素(OR=13.635、4.953、14.000、12.667,P<0.05)。ROC曲线显示:他汀类药物用量的AUC为0.833,最佳截断值为18.34 mg/d;LDL-C的AUC为0.849,最佳截断值为2.01 mmol/L;新生内膜负荷的AUC为0.908,最佳截断值为48.96%,敏感度、特异度分别为90.00%、82.00%。结论他汀类药物、LDL-C和新生内膜负荷对稳定型冠心病患者PCI术后ISR具有较好预测价值,OCT特征之新生内膜负荷可作为评估稳定型冠心病患者PCI术后ISR风险的有效指标。

Objective To explore the correlation between the characteristics of optical coherence tomography(OCT)in coronary artery and the risk of in-stent restenosis(ISR)in patients with stable coronary heart disease after percutaneous coronary intervention(PCI).Methods A retrospective analysis was conducted,including 100 patients with stable coronary heart disease who underwent PCI in Qingdao Cardiovascular Disease Hospital from August 2021 to December 2023 as the research object,and one-year follow-up was completed.According to the occurrence of ISR within one year after PCI,patients were divided into the ISR group(50 cases)and the non-ISR group(50 cases).Clinical data and OCT characteristics of coronary artery were compared between the two groups.The influencing factors of ISR after PCI were analyzed by multivariate Logistic regression analysis.The predictive efficacy of the influencing factors on ISR after PCI was further analyzed by plotting receiver operating characteristic(ROC)curves.Results The dosage of statins in the ISR group was lower than that in the non-ISR group,while the cholesterol and low-density lipoprotein cholesterol(LDL-C)levels were higher than those in the non-ISR group,and the mininmum lumen diameter(MLD)in the ISR group was smaller than that in the non-ISR group(t=11.596,5.562,8.498,10.185;P<0.05).The lumen area and neointimal load in the ISR group were higher than those in the non-ISR group,and the proportions of heterogeneous intima,lipid plaques,and calcification were also higher in the ISR group(t/χ2=10.248,3.581,9.180,5.769,7.440;P<0.05).Multivariate Logistic regression analysis showed that dosage of statins as a protective factor of ISR in patients with stable coronary heart disease after PCI(OR=0.612,P<0.05),while LDL-C,neointimal load,heterogeneous intima,and calcification were risk factors for ISR(OR=13.635,4.953,14.000,12.667;P<0.05).ROC curve analysis showed that the area under the curve(AUC)for dosage of statins was 0.833,and the optimal cutoff value was 18.34 mg/d;the AUC for LDL-C was 0.849,and the optimal cutoff value was 2.01 mmol/L;the AUC of neointimal load was 0.908,and the optimal cutoff value was 48.96%,the sensitivity and specificity were 90.00%and 82.00%,respectively.Conclusion The dosage of statins,LDL-C,and neointimal load have good predictive value for ISR in patients with stable coronary heart disease after PCI.Neointimal load,as one of OCT features,can be used as effective indicators to evaluate the risk of ISR in patients with stable coronary heart disease after PCI.