Prognosis of spontaneous coronary artery dissection treated by percutaneous coronary intervention with optical coherence tomography
Prognosis of spontaneous coronary artery dissection treated by percutaneous coronary intervention with optical coherence tomography
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DOI：
10.1016/j.jjcc.2017.03.009
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发表时间：
2017-11-01
影响因子：
2.5
通讯作者：
Akasaka, Takashi
中科院分区：
文献类型：
--
作者：
Nishiguchi, Tsuyoshi;Tanaka, Atsushi;Akasaka, Takashi
背景资料：尽管约有一半的自发性冠状动脉夹层（SCAD）患者面临持续坏死，但由于血管造影引导下经皮冠状动脉介入治疗（PCI）的并发症发生率较高，因此建议采用保守治疗。本研究的目的是探讨光学相干断层扫描（OCT）引导下PCI治疗SCAD的临床结局。方法：本研究包括连续306例接受OCT引导下PCI的急性冠状动脉综合征（ACS）患者。根据OCT的罪犯病变形态，将患者分为四组：SCAD组、斑块破裂（PR）组、钙化结节（CN）组和病因不明（UE）组。成功的PCI定义为最终血管造影中心肌梗死血流3级的溶栓，无任何并发症。结果：OCT显示SCAD12例，PR149例，CN16例，UE129例。PCI成功率无显著差异（SCAD 91.7%，PR 85.2%，CN 81.2%，UE 86.8%，p = 0.88），而2例SCAD患者需要重新定位导丝（p < 0.01）。平均随访时间为17.1 ± 13.3个月。结论：OCT引导下PCI治疗SCAD和其他ACS病因的临床结局良好。OCT引导的PCI可能成为SCAD合并持续坏死的治疗选择。(C)2017年日本心脏病学院。由爱思唯尔有限公司出版。保留所有权利。
Background: Although about half of patients with spontaneous coronary artery dissection (SCAD) face ongoing necrosis, conservative therapy is recommended due to a high complication rate in angiography-guided percutaneous coronary intervention (PCI). The aim of this study was to investigate clinical outcomes of SCAD treated by optical coherence tomography (OCT)-guided PCI.Methods: This study consisted of consecutive 306 patients with acute coronary syndrome (ACS) who underwent OCT-guided PCI. Based on the culprit lesion morphology by OCT, patients were assigned to four groups: a SCAD group, a plaque rupture (PR) group, a calcified nodule (CN) group, and an undetermined etiology (UE) group. Successful PCI was defined as thrombolysis in myocardial infarction flow grade 3 in final angiography without any complications. Primary endpoint was defined as occurrence rate of major adverse cardiac events (MACE) including cardiac death, myocardial infarction, and unstable angina pectoris.Results: OCT revealed 12 SCADs, 149 PRs, 16 CNs, and 129 UEs, respectively. No significant difference was observed in the success rate of PCI (SCAD 91.7%, PR 85.2%, CN 81.2%, UE 86.8%, p = 0.88), while wire repositioning was needed in 2 SCAD cases (p < 0.01). The mean follow-up periods were 17.1 13.3 months. No significant difference was observed in MACE among the groups (p = 0.56).Conclusions: The clinical outcomes of OCT-guided PCI for SCAD were favorable, as well as those for other ACS etiologies. OCT-guided PCI could become a therapeutic option for SCAD compromised with ongoing necrosis. (C) 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.