血管内超声与光学相干断层显像对冠状动脉分叉病变手术策略及预后影响的对照研究

摘要

Objective To investigate the reliability of the intravascular ultrasound(IVUS)and optical coherence tomography(OCT)in stenting strategy selection and its prognostic impact in coronary bifurcation lesions.Methods A total of 157 patients with coronary artery disease were prospectively studied by using angiography,OCT,and IVUS. Quantitative image analyses of the coronary bifurcation lesions were performed.The stenting strategy selection and its prognostic impact were evaluated.Results In the clinical study,the mean minimum lumen diameter(MLD)and the minimum lumen area(MLA) measured by QCA were significantly smaller than those measured by IVUS and OCT (P <0.05).Both MLD and MLA exhibited a significant correlation between QCA,IVUS and OCT.Kaplan-Meier analysis showed that the single stents strategy was more helpful in reducing postoperative cardiovascular events than double stents (P<0.05);there was no difference between the IVUS and OCT groups (P >0.05),although the OCT seems better in the follow-up.Conclusions IVUS and OCT provide accurate and reproducible quantitative measurements of coronary artery,all of them were reliable in stenting strategy selection.%目的：对比血管内超声(IVUS)及光学相干断层显像(OCT)对冠状动脉分叉病变经皮冠状动脉介入治疗(PCI)手术策略选择及预后的影响。方法冠状动脉造影明确为分叉病变的患者157例,使用冠状动脉定量分析(QCA)测量最小管腔直径(MLD)、最小管腔横截面积(MLA)、参照管腔直径(RLD),其后随机进行 IVUS (84例)和 OCT检查(73例),测量并比较上述参数与 QCA测值的差异；比较不同方法所指导的支架植入方案心血管事件发生率。结果通过 IVUS 及 OCT 所测冠状动脉 MLD、MLA、RLD 均高于 QCA 法,其中 MLD、MLA 差异有统计学意义(P <0.05),而RLD测值差异无统计学意义。Bland-Altman检验显示通过 IVUS、OCT 测量 MLD与 QCA 法相比,其平均测量差异分别为-0.18 mm和0.09 mm,相关系数r分别为0.89、0.88；IVUS、OCT测量MLA与 QCA法相比,其平均测量差异分别为0.01 mm 和0.04 mm,相关系数 r 分别为0.91、0.90。Kaplan-Meier分析显示单支架策略在减少术后心血管事件方面优于双支架策略(P <0.05)；OCT 指导PCI策略选择组在术后心血管事件方面优于 IVUS组,但二者差异无统计学意义(P >0.05)。结论IVUS 和OCT 均可用于指导分叉病变患者PCI 策略选择。