天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (2): 150-154.doi: 10.11958/20181577

• 临床研究 • 上一篇    下一篇

血管内超声指导NSTE-ACS非罪犯病变治疗策略的研究

马克静1 ， 刘玉洁2△， 张颖2△   

  1.  1天津医科大学胸科临床学院 （邮编300222）； 2天津市胸科医院心内四科
  • 收稿日期:2018-10-18 修回日期:2019-01-24 出版日期:2019-02-15 发布日期:2019-02-15
  • 通讯作者: 马克静 E-mail:1120745225@qq.com
  • 基金资助:
    天津市卫生行业重点攻关项目

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

MA Ke-jing1 , LIU Yu-jie2△, ZHANG Ying2△   

  1. 1 Thoracic Clinical College, Tianjin Medical University, Tianjin 300222, China; 2 The Forth Department of Cardiology, Tianjin Chest Hospital
  • Received:2018-10-18 Revised:2019-01-24 Published:2019-02-15 Online:2019-02-15
  • Contact: Ke-Jing MA E-mail:1120745225@qq.com

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摘要： 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 （NSTE- ACS） 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组 （148例） 和CAG组 （147例）， IVUS组对NCL进行灰阶 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%， χ2 =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-rank χ2 =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。

关键词:  急性冠状动脉综合征, 冠状动脉造影, 血管内超声, 非罪犯病变, 经皮冠状动脉介入治疗, 主要不良心血管事件

Abstract: 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 (NSTE- ACS) with multi-vessel disease. Methods A 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 prevention drug treatment. The major adverse cardiovascular events (MACE) and disease-related quality of life assessment were followed up and compared between the two groups. Results (1) The stent implantation rate was significantly higher in the IVUS 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 showed that there was no significant difference in MACE incidence between the two groups (5.52% vs. 1.37%， χ2 =2.589， P＞0.05). The degree of physical activity limitation, angina pectoris frequency, and disease cognition score were significantly better in the IVUS group than those of the CAG group (P＜0.05). The Kaplan-Meier curve was used to compare the event-free survival time of the two groups, and there was no significant difference between the two groups (94.5% vs. 98.6％， Log-rank χ2 =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.

Key words: acute coronary syndrome, coronary arteriography, intravascular ultrasound, non-culprit lesions, percutaneous coronary intervention, major adverse cardiovascular events