Clinical study on the effect of intravascular ultrasound on medication and prognosis of patients with ischemia and non-obstruc-tive coronary artery disease
Objective To analyze the effect of intravascular ultrasound(IVUS)on medication and prognosis of patients with ischemia and non-obstructive coronary artery disease(INOCA).Methods A total of 160 patients with INOCA were selected,who were admitted to the Department of Cardiology of Shanghai Putuo District Liqun Hospital from August 2019 to July 2021.The patients were divided into observation group and control group,with 80 cases in each group,according to whether IVUS examination was performed.And the observation group was further divided into severe stenosis subgroup(plaque burden ≥30％)and mild stenosis subgroup(plaque burden＜30％)according to the IVUS examination results.Coronary angiography(CAG)was performed in both groups and they were followed up for one year.The imaging examinations,medication and major adverse cardiovascular events(MACE)within one year of the two groups were recorded,and the total drug scores of the two groups were calculated.Regression analysis of the total drug scores and the presence or absence of IVUS examination was performed in the two groups.The occurrence of MACE within one year was compared between the two groups,and Cox risk analysis was performed to analyze the influencing factors of MACE within one year in the two groups.Results In the observation group,38 cases(47.5％)were found to have unstable plaques that could not be found by CAG,and 5 cases(6.3％)were found to have myocardial bridges that were not found by CAG.There were no significant differences between the two groups in the degree of coronary artery stenosis,the proportion of myocardial bridges found by CAG,and the proportion of confirmed myocardial bridges(all P＞0.05).The use rates of angiotension converting enzyme inhibitors(ACEI),angiotensin receptor antagonists(ARB)and β-blockers in the observation group were higher than those of the control group,and the differences were statistically significant(all P＜0.05).The use rate of statins in the severe stenosis subgroup was higher than that in the mild stenosis subgroup,while that of calcium channel blockers was lower compared with the mild stenosis subgroup,and the differences were statistically significant(all P＜0.05).There were no significant differences in the use rates of other drugs between the two subgroups(all P＞0.05).Regression analysis showed that IVUS examination was the influencing factor for the total drug scores in the two groups(P＜0.05).Within one year of follow-up,3 cases(3.8％)of MACE occurred in the observation group and 10 cases(12.5％)in the control group,the difference of which was statistically significant(P=0.043).Cox risk analysis showed that IVUS examination and CAG grade were the influencing factors for the occurrence of MACE within one year in the two groups(P＜0.05).Conclusion IVUS examination can guide the medication and improve the prognosis of INOCA patients,which is worthy of promotion.
万方数据
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