血管内超声指导急性冠脉综合征患者冠状动脉非左主干临界病变治疗的临床效果

摘要

Objective To evaluate the long-term clinical outcomes of intravascular ultrasound (IVUS) in guiding the treatment of non-left main intermediate coronary lesions for patients of acute coronary syndrome (ACS).Methods A total of 25 patients with intermediate coronary lesions (stenosis of 40％-70％) confirmed by coronary angiography were performed with IVUS.When MLA≥4 mm2,we deferred the PCI treatment and performed optimal medical treatment (OMT).The patient were followed up for 12 month.The primary outcome was target vessel revascularization (TVR) and secondary outcome was major adverse cardiac events (MACEs).Results A total of 25 lesions of 25 patients were examined by IVUS.19(76％) lesions were attenuated plaque,4(16％)were echo-lucent plaque,2(8％) were calcified plaque.Most of the plaque (18/25,72％) were eccentric.Positive remodeling was found in 20(80％) lesions and negative remodeling in 5(20％) lesions with meanremodeling index of 1.17±0.15.Thrombus was found in 1 case,accounting for 4％.The diameter stenosis,area stenosis,minimal lumen area and the reference diameter mea-sured by IVUS were larger than those measured by quantitative coronary angiography (all P＜0.05).One patient with non-ST segment elevated myocardiac infarction was performed revascularization because MI attacked again,and 2 patients with Unstable angina were treated with OMT but they were still rehospitalization because of angina occurred repeatedly.The incidence of TVR was 4.00％,so as 16.00％ of MACE.Conclusion IVUS can be used to guide the treatment of non-left main intermediate coronary lesions for patients of acute coronary syndrome.%目的 观察血管内超声指导急性冠脉综合征患者冠状动脉非左主干临界病变治疗中的1年临床效果.方法 选取冠脉造影提示冠脉临界病变(40％～70％狭窄)且血管内超声检查提示最小管腔面积＞4.0 mm2的25例急性冠脉综合征患者,延迟行冠状动脉介入治疗,采用冠心病优化药物治疗,随访1年,观察主要终点为靶血管重建,次要终点为主要心血管不良事件.结果 25例病变中19例(76％)为回声衰减斑块,4例(16％)为回声透亮斑块,2例(8％)为钙化斑块;共18例(72％)为偏心性斑块;20例(80％)正性重构,5例(20％)负性重构;重构指数为1.17±0.15.1例发现血栓,占4％.血管内超声测得的直径狭窄率、面积狭窄率、最小管腔面积和参照血管直径均大于定量冠状动脉造影所测得的数值(P均＜0.05).1例非ST段抬高型心肌梗死患者因再次发生心肌梗死行血运重建,2例不稳定型心绞痛患者经药物治疗后仍反复发生心绞痛再次住院,靶血管重建发生率为4.00％,主要心血管不良事件发生率为16.00％.结论 血管内超声可以用于指导急性冠脉综合症患者非左主干冠脉临界病变延迟介入治疗.