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目的:评价血管内超声(IVUS)指导下的无保护左主干病变介入治疗的临床疗效。方法:纳入2012年1月至2015年12月入住我院的368例经冠状动脉(冠脉)造影证实无保护左主干狭窄超过50%的冠心病患者为研究对象,除外急性ST段抬高的急性心肌梗死患者,按倾向匹配得分法,1∶2分为IVUS组和常规造影介入(CAG)组,最终36例患者入选IVUS组,72例患者入选CAG组,比较2组患者的临床特征、住院期间和1年随访期间的主要心脏不良事件(MACE)(包括死亡、心绞痛复发及因缺血所致的再次血运重建等)。结果:2组患者年龄、性别构成、吸烟、高血压、糖尿病、高血脂、脑卒中、陈旧性心肌梗死、既往经皮冠脉介入术(PCI)史和外周血管疾病史无明显差异(均P>0.05)。2组患者在最小管腔直径[(1.06±0.42)mm比(1.01±0.39)mm,P=0.697]、管腔直径狭窄百分比(83.9%±10.4%比87.6%±9.0%,P=0.064)、死亡率(0%比2.8%,P=0.551)、心绞痛复发率(8.3%比25%,P=0.071)、再次靶血管血运重建率(5.6%比13.9%,P=0.330)也无明显差异,但与CAG组相比,IVUS组的参考血管直径[(3.53±0.52)mm比(3.29±0.47)mm,P=0.018]、植入支架直径[(3.72±0.34)mm比(3.44±0.41)mm,P=0.001]、高压后扩球囊直径[(3.99±0.43)mm比(3.54±0.47)mm,P=0.000]及术后最小管腔直径[(3.88±0.40)mm比(3.49±0.42)mm,P=0.000]均明显大,MACE的发生率(8.3%比27.8%,P=0.038)明显降低。结论:IVUS指导下的无保护左主干病变介入治疗安全、有效,可明显改善此类患者的临床预后。
Objective: To evaluate the clinical effect of interventional therapy of unprotected left main disease under the guidance of intravascular ultrasound (IVUS). Methods: A total of 368 CHD patients admitted to our hospital from January 2012 to December 2015 who underwent coronary artery (coronary) angiography to confirm the unprotected left main stenosis more than 50% were enrolled as study subjects except for acute ST-segment elevation Patients with acute myocardial infarction were divided into IVUS group and conventional angiographic intervention group (CAG) according to the propensity score method. Finally, 36 patients were enrolled in the IVUS group and 72 patients were enrolled in the CAG group. The clinical features, Major adverse cardiac events (MACE) during hospitalization and 1-year follow-up (including death, recurrence of angina, revascularization due to ischemia, etc.). Results: There were no significant differences in age, sex composition, smoking history, hypertension, diabetes, hyperlipidemia, stroke, old myocardial infarction, previous percutaneous coronary intervention (PCI) and history of peripheral vascular disease > 0.05). There was no significant difference between the two groups in the minimum lumen diameter [(1.06 ± 0.42) mm (1.01 ± 0.39) mm, P = 0.697], lumen diameter stenosis percentage (83.9% ± 10.4% vs. 87.6% ± 9.0%, P = 0.064) , Mortality (0% vs 2.8%, P = 0.551), recurrence rate of angina (8.3% vs 25%, P = 0.071), and again target revascularization (5.6% vs. 13.9%, P = 0.330) (3.53 ± 0.52) mm vs (3.29 ± 0.47) mm, P = 0.018] in the IVUS group compared with that in the CAG group [(3.72 ± 0.34) mm vs (3.99 ± 0.43) mm (3.54 ± 0.47) mm, P = 0.000] and the smallest postoperative diameter of the lumen [(3.88 ± 0.40) mm ± 0.41) mm, P = 0.001] (3.49 ± 0.42) mm, P = 0.000], and the incidence of MACE was significantly lower (8.3% vs 27.8%, P = 0.038). Conclusion: The interventional treatment of unprotected left main disease under the guidance of IVUS is safe and effective, which can significantly improve the clinical prognosis of these patients.