摘要
目的 通过血管内超声(IVUS)探讨左主干经皮冠脉介入(PCI)治疗术中急性残余支架贴壁不良(ARSM)的影响因素,并评估其对患者术后远期预后的影响.方法 本研究收集 2014年 12月 1日～2020年 10月 31日在山东第一医科大学第一附属医院心内科 154例因左主干冠状动脉病变接受PCI治疗患者的病例资料及IVUS结果,评估了ARSM可能的影响因素,并探讨了其与患者临床结局(MACCE)的相关性.结果 与Non-ARSM组比较,ARSM组LM病变部位在开口或体部比例低,在远端分叉处比例高(均P<0.05).两组患者年龄、性别、合并高血压、糖尿病、血脂异常、肌酐水平、LVEF、肌钙蛋白、既往血运重建、术前诊断、血管病变数量等临床因素均无统计学差异.与Non-ARSM组比较,ARSM组支架对称性>0.3比例高(P<0.01),支架累及左冠状窦比例低(P<0.05).而在支架直径、支架长度、支架累计分叉、单支架数量等方面无统计学差异.Logistic回归分析示支架对称性>0.3与ARSM存在相关性(OR=0.11,95%CI:0.03～0.43,P=0.001).支架对称性与钙化程度呈正相关(B=0.02,95%CI:0.01～0.04,P<0.01),与最小支架内面积呈负相关(B=-0.01,95%CI:-0.01～0.00,P<0.05).Kaplan-Meier曲线分析表明ARSM组与Non-ARSM组患者的生存率未发现显著差异.COX比例风险回归分析示 ARSM与 MACCE(HR=1.08,95%CI:0.44～2.66,P=0.872)及全因死亡(HR=8.03,95%CI:0.89～72.57,P=0.064)无明确相关,且ARSM与非致命性心肌梗死(HR=0.48,95%CI:0.09～2.53,P=0.388)、非致命性脑卒中(HR=0.74,95%CI:0.13～4.28,P=0.735)以及TVR(HR=1.59,95%CI:0.34～7.40,P=0.557)亦无相关性.结论 支架对称性>0.3是ARSM的影响因素,在无保护左主干冠状动脉行PCI的患者中,有限的ARSM并不影响患者的远期预后.
Abstract
AIM To investigate the influence factors of acute residual stent malapposition(ARSM)within the left main coronary artery(LMCA)using intravascular ultrasound(IVUS)and evaluate its impact on long-term prognosis in patients undergoing percutaneous coronary intervention(PCI).METHODS This study collected clinical data and IVUS results of 154 patients who underwent PCI for LMCA disease at the Department of Cardiology,the First Affiliated Hospital of Shandong First Medical University from December 1,2014 to October 31,2020.The possible influencing factors of ARSM were assessed and its correlation with major adverse cardiac and cerebrovascular events(MACCE)was explored.RESULTS Compared with the Non-ARSM group,the ARSM group had a lower proportion of LM lesions at the opening or body,and a higher proportion at the distal bifurcation(both P<0.05).There was no statistical difference between the two groups in age,gender,hypertension,diabetes,dyslipidemia,creatinine level,LVEF,troponin,previous blood supply reconstruction,preoperative diagnosis,number of vascular lesions and other clinical factors.Compared with the Non-ARSM group,the ARSM group had a higher proportion of stent symmetry>0.3(P<0.01)and a lower proportion of stent involvement in the left coronary sinus(P<0.05).There was no statistically significant difference in terms of stent diameter,stent length,cumulative bifurcation of the stent,and the number of single stents.Logistic regression analysis showed a correlation between stent symmetry>0.3 and ARSM(OR=0.11,95%CI:0.03～0.43,P=0.001).The symmetry of the stent is positively correlated with the degree of calcification(B=0.02,95%CI:0.01～0.04,P<0.01),and negatively correlated with the minimum stent area(B=-0.01,95%CI:-0.01～0.00,P<0.05).Kaplan Meier curve analysis showed no significant difference in survival rates between the ARSM group and the Non-ARSM group patients.COX proportional hazards regression analysis showed no clear correlation between ARSM and MACCE(HR=1.08,95%CI:0.44～2.66,P=0.872)and all-cause mortality(HR=8.03,95%CI:0.89～72.57,P=0.064),and there was no correlation between ARSM and non fatal myocardial infarction(HR=0.48,95%CI:0.09～2.53,P=0.388),non fatal stroke(HR=0.74,95%CI:0.13～4.28,P=0.735),and TVR(HR=1.59,95%CI:0.34～7.40,P=0.557).CONCLUSION Stent symmetry>0.3 is an influential factor for ARSM.Limited ARSM is not associated with the long-term prognosis in patients of LMCA disease after PCI.
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