通过 IVUS 或冠状动脉生理学推迟左冠状动脉主干再通术 - SWEDEHEART 登记的长期结果。

IF 3.2 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS International journal of cardiology Pub Date : 2024-11-11 DOI:10.1016/j.ijcard.2024.132726
Karolina Berntorp, Moman A Mohammad, Sasha Koul, Troels Yndigegn, Sofia Bergman, Sammy Zwackman, Rikard Linder, Sebastian Völz, Ole Fröbert, David Erlinge, Matthias Götberg
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引用次数: 0

摘要

背景:血管内超声(IVUS)可指导有关左冠状动脉主干(LMCA)的延期决策并改善预后。需要进一步研究冠状动脉生理学来指导 LMCA 的血管再通。我们的目的是通过瞬时无波比(iFR)或分数血流储备(FFR)评估使用IVUS或冠状动脉生理学进行LMCA延期的结果:方法:2014 年 1 月至 2022 年 2 月期间,SWEDEHEART 登记处纳入了接受 IVUS 或冠状动脉生理学评估的 LMCA 患者。排除标准为最小管腔面积为 2、iFR ≤ 0.89、FFR ≤ 0.80、对 LMCA、左前降支近端和周挠动脉近端病变进行临时经皮冠状动脉介入治疗、计划进行选择性血管再通术以及计划进行瓣膜手术。主要结果是重大心脏不良事件(MACE),定义为全因死亡、心肌梗死和计划外血运重建的综合结果。统计分析采用卡普兰-梅耶事件发生率和多变量泊松回归:1552名患者推迟了LMCA血管再通,其中33.6%采用IVUS,66.4%采用冠状动脉生理学(iFR 11.3%对FFR 55.0%)。中位随访时间为 2.7 年。MACE方面无明显差异(IVUS为40.2%,冠状动脉生理学为35.5%;调整RR:1.18;95 %CI:0.97-1.44;P = 0.09)。所有调查亚组的结果一致。IVUS组的全因死亡率更高(调整后RR:1.38;95 %CI:1.03-1.83;P = 0.03):结论:使用IVUS或冠状动脉生理学方法推迟LMCA病变的冠状动脉血运重建在我们的综合终点上没有差异。我们观察到,使用 IVUS 的全因死亡风险更高。
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Deferral of left main coronary artery revascularization via IVUS or coronary physiology - Long-term outcomes from the SWEDEHEART registry.

Background: Intravascular ultrasound (IVUS) guides deferral decision-making regarding the left main coronary artery (LMCA) and improves outcomes. Further studies regarding coronary physiology to guide revascularization in the LMCA are needed. Our aim was to evaluate the outcome of LMCA deferral using IVUS or coronary physiology via instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR).

Methods: Between January 2014 and February 2022, patients undergoing evaluation with either IVUS or coronary physiology in the LMCA were included from the SWEDEHEART registry. Exclusion criteria were a minimum luminal area < 6 mm2, iFR ≤ 0.89, FFR ≤ 0.80, ad hoc percutaneous coronary intervention of lesions in the LMCA, proximal left anterior descending artery, and proximal circumflex artery, planned elective revascularization, and planned valvular surgery. The primary outcome was major adverse cardiac events (MACE), defined as a composite of all-cause death, myocardial infarction, and unplanned revascularization. Kaplan-Meier event rates and multivariable Poisson regression were used for the statistical analyses.

Results: Deferral of revascularization in the LMCA was performed in 1552 patients, 33.6 % with IVUS and 66.4 % with coronary physiology (iFR 11.3 % vs. FFR 55.0 %). The median follow-up time was 2.7 years. No significant difference was seen in MACE (IVUS 40.2 % vs. coronary physiology 35.5 %; adjusted RR: 1.18; 95 %CI: 0.97-1.44; p = 0.09). The results were consistent across all investigated subgroups. The rate of all-cause death was higher in the IVUS group (adjusted RR: 1.38; 95 %CI: 1.03-1.83; p = 0.03).

Conclusions: Deferral of coronary revascularization in LMCA lesions using IVUS or coronary physiology did not differ in our combined endpoint. We observed a higher risk of all-cause death using IVUS.

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来源期刊
International journal of cardiology
International journal of cardiology 医学-心血管系统
CiteScore
6.80
自引率
5.70%
发文量
758
审稿时长
44 days
期刊介绍: The International Journal of Cardiology is devoted to cardiology in the broadest sense. Both basic research and clinical papers can be submitted. The journal serves the interest of both practicing clinicians and researchers. In addition to original papers, we are launching a range of new manuscript types, including Consensus and Position Papers, Systematic Reviews, Meta-analyses, and Short communications. Case reports are no longer acceptable. Controversial techniques, issues on health policy and social medicine are discussed and serve as useful tools for encouraging debate.
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