Association of stent-induced changes in coronary geometry with late stent failure: Insights from three-dimensional quantitative coronary angiographic analysis
Association of stent-induced changes in coronary geometry with late stent failure: Insights from three-dimensional quantitative coronary angiographic analysis
复制标题
支架引起的冠状动脉几何形状变化与晚期支架失效的关联：三维定量冠状动脉造影分析的见解
DOI：
10.1002/ccd.27520
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发表时间：
2018
影响因子：
2.3
通讯作者：
Evelyn Regar
中科院分区：
文献类型：
--
作者：
Buchun Zhang;Shengxian Tu;Antonions Karanasos;Robert-Jan van Genus;Peter de Jaegere;Felix Zijlstra;Evelyn Regar
血管成角和支架植入后血管几何形态的巨大变化与支架失效的发生之间的关系尚不清楚。我们试图通过三维定量冠状动脉造影（3D QCA）研究支架置入后冠状动脉弯曲角度的变化与晚期支架失效风险的关系。方法采用最新开发的3D QCA软件，在心脏周期、支架置入术前后计算晚期支架失效和未发生支架失效的冠状动脉病变的弯曲角度。结果40例支架失效病变（病例）与47例无支架失效病变（对照组）成功匹配。冠状动脉造影随访的平均时间为1011天，对照组为1109天（P= 0.14）。在支架失效时，支架置入后的收缩弯曲角较小（14.45°[12.18,17.68]vs . 18.20°[14.00,20.30]，P= 0.01），而支架诱导的收缩弯曲角变化明显较大（4.15°[1.13,7.20]vs . 1.80°[-1.90,4.40]，P= 0.004）。多变量logistic回归分析提示，支架置入后收缩弯曲角（优势比：0.88;95% CI: 0.79 ~ 0.99；P= 0.03）和收缩弯曲角减小（优势比：1.13;95% CI: 1.02 ~ 1.26；P= 0.03）是支架失效的预测因素。结论我们的研究表明，支架植入改变了冠状动脉的自然弯曲过程，冠状动脉弯曲角度的减小可能是导致支架失效的主要原因。
BackgroundThe relationship between vessel angulation and large changes in vessel geometry after stent implantation and the occurrence of stent failure still remains unclear. We sought to investigate the association of the change in the coronary bending angle after stenting and the risk for late stent failure by three‐dimensional quantitative coronary angiography (3D QCA).MethodsThe bending angle in coronary lesions that presented with late stent failure and those without stent failure was computed during the cardiac cycle, before and after stenting using a recently developed 3D QCA software.ResultsA total of 40 lesions with stent failure (cases) were successfully matched to 47 lesions without stent failure (controls).The mean duration to follow‐up coronary angiography was 1,011 days in cases and 1,109 days in the control group (P= 0.14). In stent failure, the systolic bending angle after stenting was smaller (14.45° [12.18, 17.68] versus 18.20° [14.00, 20.30],P= 0.01), while the stent‐induced change in systolic bending angle was significantly larger (4.15° [1.13, 7.20] versus 1.80° [–1.90, 4.40],P= 0.004). Multivariable logistic regression analysis suggested that systolic bending angle after stenting (odds ratio: 0.88; 95% CI: 0.79–0.99;P= 0.03), and decrease in systolic bending angle after stenting (odds ratio: 1.13; 95% CI: 1.02–1.26;P= 0.03) were predictors of stent failure.ConclusionsOur study suggests that a change in the natural tortuous course of the coronaries by stent implantation with the decrease in coronary bending angle is a potentially major contributor in stent failure.