The Application of Optical Coherence Tomography after the Stent Implantation in Patients with the Acute Coronary Syndrome
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摘要:
目的 探讨使用PPCI术治疗ACS患者时在术中完成支架置入后即刻用OCT评价的价值。 方法 选取从2019年6月至2022年8月在昆明医科大学附属延安医院心血管内科接受PPCI手术的172例ACS患者作为研究对象（OCT指导组），在PPCI术中支架置入后即刻使用OCT进行评价，根据评价结果制定后续治疗策略。从单纯CAG指导的PPCI患者数据库中使用倾向性评分方法回顾性顺序1:1匹配172例ACS患者作为对照组（CAG指导组）。对比OCT和CAG检查后后续治疗策略的差异、无复流发生率和6个月临床终点事件的发生率。 结果 OCT指导组56例患者存在支架膨胀不全，78例患者存在支架贴壁不良，18例患者存在支架边缘夹层。OCT指导组球囊后扩张和置入第2枚支架数量明显多于CAG指导组（P < 0.05），而OCT指导组的无复流现象发生率明显低于CAG指导组（P < 0.05），OCT指导组的靶血管再次急性心肌梗死发生率和再次靶血管血运重建发生率低于CAG指导组（P < 0.05）。 结论 OCT检查能准确识别ACS患者支架置入后即刻是否存在支架贴壁不良、支架膨胀不全、有无支架边缘夹层，并根据评估结果制定不同的后续治疗策略，从而明显减少了ACS患者PPCI术后出现与支架置入相关的近期不良事件的可能性，实现了ACS患者PPCI个体化的精准治疗。 Abstract:Objective To investigate the effect of OCT after the stent implantation in patients with the Acute Coronary Syndrome （ACS）. Methods 172 patients with the ACS admitted to Yan’an Hospital Affiliated to Kunming Medical University from June 2019 to August 2022 were included in this study. They were treated with PPCI and accepted the assessment of OCT after the stent implantation. According to the result of OCT, they were treated with different methods. These 172 patients were matched with other 172 patients guided by CAG alone from PPCI patient database in order of 1∶1 by propensity score．The effects of the two strategies on the following treatment methods, the incidence of no-reflow phenomenon （NRP） and 6-month clinical follow-up results were compared and evaluated. Results 56 patients in the OCT guidance group had the incomplete stent expansion, 78 patients had the poor stent adhesion, and 18 patients had the stent edge dissection. The number of balloon dilation and placement of the second stent in the OCT guided group was significantly higher than that in the CAG guided group （P < 0.05）, and the incidence of no reflow phenomenon in the OCT guided group was significantly lower than that in the CAG guided group （P < 0.05）. The incidence of recurrent acute myocardial infarction and retarget vessel revascularization in the OCT guided group was lower than that in the CAG guided group （P < 0.05）. Conclusion OCT examination can accurately identify whether ACS patients have the poor stent adhesion, incomplete stent expansion, and presence or absence of the stent edge dissection immediately after the stent placement. Based on the evaluation results, different follow-up treatment strategies are formulated, significantly reducing the possibility of recent adverse events related to the stent placement in ACS patients after PPCI surgery, and achieving personalized and precise treatment of ACS patients’ PPCI. -
表 1 2组患者的临床资料 [（
$ \bar{x} \pm s $ ）/n（%）]Table 1. The clinical data of two groups of patients with ACS [（
$\bar{x} \pm s $ ）/n（%）]组别 n 性别 年龄（岁） 高血压 糖尿病 病变相关血管 男 女 前降支 回旋支 右冠脉 OCT指导组 172 119（69.2） 53（30.8） 59.5±22.6 73（42.4） 48（27.9） 83（48.3） 33（19.2） 56（32.6） CAG指导组 172 127（73.8） 45（26.2） 62.1±24.8 69（40.1） 51（29.6） 89（51.7） 30（17.4） 53（30.8） χ2/t - 0.91 0.76 0.58 0.71 0.492 P - 0.34 0.74 0.75 0.67 0.837 
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表 2 2 组患者术前TIMI 0～1 级、球囊后扩张、无复流、支架边缘置入第2枚支架发生率的比较 [n（%）]
Table 2. Comparison of TIMI0-1 incidence of dilation after stent placement NRP the placement of second stent between the two groups [n（%）]
组别 n 术前TIMI0-1 级 球囊后扩张例数 无复流例数 置入第2枚支架例数 OCT指导组 172 96（55.8） 82（47.7）* 18（10.5）* 14（8.13）* CAG指导组 172 101（58.7） 67（38.9） 33（19.1） 8（4.65） χ2 - 0.21 4.6 4.3 4.1 P - 0.64 0.036# 0.040# 0.042# 与CAG指导组比较，*P < 0.05；#P < 0.05。
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表 3 2 组患者术后6个月临床终点事件的比较 [n（%）]
Table 3. Comparison of 6-month clinical follow-up results between the two groups [n（%）]
组别 n 随访人数 心血管死亡 再次心梗 心绞痛再入院 出血事件 OCT指导组 172 167（97.5） 1（0.5） 2（1.2）* 1（0.5）* 8（4.7） CAG指导组 172 166（96.1） 1（0.5） 6（3.5） 4（2.3） 9（5.2） χ2 - 0.08 - 4.34 4.72 0.05 P - 0.928 - 0.046# 0.042# 0.834 与CAG指导组比较，* P < 0.05；#P < 0.05。
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