{"title":"光学相干断层扫描引导下经皮冠状动脉介入治疗急性冠状动脉综合征的疗效观察。","authors":"Hiroshi Okamoto, Teruyoshi Kume, Takeshi Nishi, Satoshi Koto, Yoshitaka Sasahira, Ryotaro Yamada, Terumasa Koyama, Tomoko Tamada, Koichiro Imai, Yoji Neishi, Shiro Uemura","doi":"10.6515/ACS.202303_39(2).20220729A","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Optical coherence tomography (OCT) is currently used as a guide for percutaneous coronary intervention (PCI), however its clinical benefit in comparison with intravascular ultrasound (IVUS) remains unclear in patients with acute coronary syndrome (ACS).</p><p><strong>Objectives: </strong>The purpose of this study was to evaluate the clinical efficacy of OCT-guided PCI in comparison with IVUS-guided PCI in patients with ACS.</p><p><strong>Methods: </strong>The study participants comprised 280 consecutive ACS patients who underwent primary PCI for de novo culprit lesions under OCT or IVUS guidance.</p><p><strong>Results: </strong>Compared with the IVUS-guided group, the OCT-guided group had lower Killip classification (p < 0.001) and lower creatinine level at baseline (0.80 ± 0.37 mg/dl vs. 1.13 ± 1.29 mg/dl, p = 0.004). Fluoroscopy time and total procedure time were significantly shorter in the OCT-guided group than in the IVUS-guided group (32 ± 13 min vs. 41 ± 19 min, p < 0.001, and 98 ± 39 min vs. 127 ± 47 min, p = 0.002, respectively). The major adverse cardiovascular event-free survival curves were similar between the OCT- and IVUS-guided groups after adjusting for clinical background using propensity score (log-rank p = 0.328).</p><p><strong>Conclusions: </strong>After adjusting for clinical background, OCT-guided PCI could provide comparable clinical outcomes to IVUS-guided PCI in patients with ACS. 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Fluoroscopy time and total procedure time were significantly shorter in the OCT-guided group than in the IVUS-guided group (32 ± 13 min vs. 41 ± 19 min, p < 0.001, and 98 ± 39 min vs. 127 ± 47 min, p = 0.002, respectively). The major adverse cardiovascular event-free survival curves were similar between the OCT- and IVUS-guided groups after adjusting for clinical background using propensity score (log-rank p = 0.328).</p><p><strong>Conclusions: </strong>After adjusting for clinical background, OCT-guided PCI could provide comparable clinical outcomes to IVUS-guided PCI in patients with ACS. 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引用次数: 0
摘要
背景:光学相干断层扫描(OCT)目前被用作经皮冠状动脉介入治疗(PCI)的指导，但在急性冠状动脉综合征(ACS)患者中，与血管内超声(IVUS)相比，其临床益处尚不清楚。目的:本研究的目的是评价oct引导下的PCI与ivus引导下的PCI在ACS患者中的临床疗效。方法:研究参与者包括280名连续的ACS患者，他们在OCT或IVUS指导下接受了首次PCI治疗新发病灶。结果:与ivus引导组相比，oct引导组的Killip分型更低(p < 0.001)，基线时肌酐水平更低(0.80±0.37 mg/dl vs. 1.13±1.29 mg/dl, p = 0.004)。oct引导组透视时间和总手术时间明显短于ivus引导组(32±13 min vs. 41±19 min, p < 0.001; 98±39 min vs. 127±47 min, p = 0.002)。在使用倾向评分调整临床背景后，OCT引导组和ivus引导组的主要不良心血管事件无生存曲线相似(log-rank p = 0.328)。结论:在调整临床背景后，oct引导下的PCI可以为ACS患者提供与ivus引导下的PCI相当的临床结果。较短的透视时间和OCT总手术时间可以减少患者的辐射暴露，也可以改善医院的工作流程。
Efficacy of Optical Coherence Tomography-Guided Primary Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome.
Background: Optical coherence tomography (OCT) is currently used as a guide for percutaneous coronary intervention (PCI), however its clinical benefit in comparison with intravascular ultrasound (IVUS) remains unclear in patients with acute coronary syndrome (ACS).
Objectives: The purpose of this study was to evaluate the clinical efficacy of OCT-guided PCI in comparison with IVUS-guided PCI in patients with ACS.
Methods: The study participants comprised 280 consecutive ACS patients who underwent primary PCI for de novo culprit lesions under OCT or IVUS guidance.
Results: Compared with the IVUS-guided group, the OCT-guided group had lower Killip classification (p < 0.001) and lower creatinine level at baseline (0.80 ± 0.37 mg/dl vs. 1.13 ± 1.29 mg/dl, p = 0.004). Fluoroscopy time and total procedure time were significantly shorter in the OCT-guided group than in the IVUS-guided group (32 ± 13 min vs. 41 ± 19 min, p < 0.001, and 98 ± 39 min vs. 127 ± 47 min, p = 0.002, respectively). The major adverse cardiovascular event-free survival curves were similar between the OCT- and IVUS-guided groups after adjusting for clinical background using propensity score (log-rank p = 0.328).
Conclusions: After adjusting for clinical background, OCT-guided PCI could provide comparable clinical outcomes to IVUS-guided PCI in patients with ACS. Shorter fluoroscopy time and total procedure time with OCT may reduce patient radiation exposure and also improve hospital workflow.
期刊介绍：
Acta Cardiologica Sinica welcomes all the papers in the fields related to cardiovascular medicine including basic research, vascular biology, clinical pharmacology, clinical trial, critical care medicine, coronary artery disease, interventional cardiology, arrythmia and electrophysiology, atherosclerosis, hypertension, cardiomyopathy and heart failure, valvular and structure cardiac disease, pediatric cardiology, cardiovascular surgery, and so on. We received papers from more than 20 countries and areas of the world. Currently, 40% of the papers were submitted to Acta Cardiologica Sinica from Taiwan, 20% from China, and 20% from the other countries and areas in the world. The acceptance rate for publication was around 50% in general.
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