血管内超声指导NSTE-ACS非罪犯病变治疗策略的研究

Study on the treatment strategy of NSTE-ACS non-culprit lesions guided by intravascular ultrasound

目的观察血管内超声(IVUS)和冠状动脉造影(CAG)指导治疗非ST段抬高型急性冠脉综合征(NSTEACS)多支病变患者非罪犯病变(NCL)的疗效。方法纳入NSTE-ACS多支病变并成功对罪犯病变(CL)行经皮冠状动脉介入治疗(PCI)的患者共295例,将患者随机分为IVUS IVUS检查,对具有斑块负荷(PB)≥70%的病变进行PCI;CAG组对NCL直径狭窄≥90%的病变进行PCI,并给予所有患者规范严格的二级预防药物治疗。随访观察比较2组患者出院后主要不良心血管事件(MACE)发生情况及疾病相关生活质量。结果 (1)IVUS组支架植入率高于CAG组(P<0.05),但患者的支架植入数量更低(P<0.05)。(2)2组患者住院费用差异无统计学意义(P>0.05)。(3)随访结果显示,2组MACE发生率差异无统计学意义(5.52%vs. 1.37%,χ~2=2.589,P>0.05);IVUS组在活动受限程度、心绞痛改善情况、疾病的认知程度方面均明显优于CAG组,差异有统计学意义(P<0.05)。生存分析结果显示,2组累积无MACE生存率差异无统计学意义(94.5%vs. 98.6%,Log-rankχ~2=3.276,P>0.05)。结论 IVUS指导NCL治疗能减少患者的支架植入数量,优化支架植入,不增加治疗费用,提高生活质量。

Objective To observe the efficacy of intravascular ultrasound(IVUS) and coronary angiography(CAG) in the treatment of non-culprit lesions(NCL) in patients with non-ST-segment elevation acute coronary syndrome(NSTEACS) with multi-vessel disease.MethodsA total of 295 patients were included in NSTE-ACS with multivessel disease and successfully underwent percutaneous coronary intervention(PCI) for criminal lesions(CL). Patients were randomly divided into IVUS-guided treatment group(n=148) and CAG-guided treatment group(n=147). The IVUS group underwent gray-scale IVUS examination of NCL. Lesions with plaque burden(PB) ≥70% were detected by PCI. Patients in CAG group with the diameter of NCL greater than 90% were performed for PCI, and all patients were given strict secondary preventiondrug treatment. The major adverse cardiovascular events(MACE) and disease-related quality of life assessment werefollowed up and compared between the two groups.Results(1) The stent implantation rate was significantly higher in theIVUS group than that of CAG group(P<0.05), but the number of stent implantation was lower in IVUS group(P<0.05).(2)There was no significant difference in the average hospital cost between the two groups(P>0.05).(3) The follow-up showedthat there was no significant difference in MACE incidence between the two groups(5.52% vs. 1.37%,χ~2=2.589,P>0.05).The degree of physical activity limitation, angina pectoris frequency, and disease cognition score were significantly better inthe IVUS group than those of the CAG group(P<0.05). The Kaplan-Meier curve was used to compare the event-freesurvival time of the two groups, and there was no significant difference between the two groups(94.5% vs. 98.6%,Log-rankχ~2=3.276,P>0.05).Conclusion IVUS-guided NCL therapy can reduce the average number of stent implantation,optimize stent implantation, not increase costs in treatment, and improve the quality of life.