Overestimation of acute lumen gain and late lumen loss by quantitative coronary angiography (compared with intravascular ultrasound) in stented lesions
Overestimation of acute lumen gain and late lumen loss by quantitative coronary angiography (compared with intravascular ultrasound) in stented lesions
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DOI：
10.1016/s0002-9149(97)00665-6
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发表时间：
1997-11-15
影响因子：
2.8
通讯作者：
Leon, MB
中科院分区：
文献类型：
--
作者：
Hoffmann, R;Mintz, GS;Leon, MB
准确测量管腔尺寸对于指导介入手术和评估急性和晚期结果至关重要。本研究比较了血管内超声（IVUS）与定量冠状动脉造影（QCA）在评估介入治疗前后和随访时的管腔尺寸方面的差异。对231例接受Palmaz-Schatz支架治疗并使用系列（介入前后和随访）IVUS和QCA进行评价的连续患者进行了筛选。由于IVUS无法测量小于成像导管的尺寸，因此排除了任何研究期间血管造影最小管腔直径（MLD）小于IVUS导管（1.0 mm）的患者，最终研究组中留下71例患者。比较IVUS和QCA测量值（参考尺寸和MLD）和计算值（直径狭窄百分比、急性管腔增益、晚期管腔丢失、丢失指数和再狭窄率）。测量变量的相关系数范围为0.641至0.816，计算变量的相关系数范围为0.280至0.680。IVUS的参考管腔尺寸始终大于QCA：介入前0.50 +/-0.52 mm（p <0.0001），介入后0.46 +/-0.45 mm（p <0.0001），随访时0.38 +/-0.53 mm（p <0.0001）。IVUS测量的MLD在介入前较大（0.17 +/-0.28 mm，p <0.0001），介入后较小（0.17 +/-0.34 mm，p <0.0001），随访时较大（0.14 +/-0.41 mm，p <0.0001）。这导致IVUS测量的急性增益和晚期丢失较小（分别为0.33 +/-0.39和0.30 +/-0.47 mm，均p <0.0001）。尽管再狭窄的测量（即，损失指数和再狭窄率）相似，但个体患者的病变分类（再狭窄与非再狭窄）存在显著差异（p = 0.002，一致率= 73%）。IVUS和QCA在测量参考和病变管腔尺寸方面存在系统差异。虽然再狭窄的指标相似，但个体患者的病变分类不同。(C)1997年由Excerpta Medico，Inc.
The accurate measurement of lumen dimensions is essential for guidance of interventional procedures and the assessment of acute and late results. This study compared intravascular ultrasound (IVUS) with quantitative coronary angiography (QCA) in the assessment of lumen dimensions before and after intervention, and at followup. Two hundred thirty-one consecutive patients treated with Palmaz-Schatz stents and evaluated using serial (before and after intervention, and follow-up) IVUS and QCA were screened. Because IVUS cannot measure dimensions smaller than the imaging catheter, patients having an angiographic minimal lumen diameter (MLD) less than the IVUS catheter (1.0 mm) during any study were excluded, leaving 71 patients in the final study group. IVUS and QCA measurements (reference dimensions and MLD) and calculations (percent diameter stenosis, acute lumen gain, late lumen loss, loss index, and restenosis rates) were compared. Correlation coefficients ranged from 0.641 to 0.816 for measured variables and from 0.280 to 0.680 for calculated variables. Reference lumen dimensions were consistently larger by IVUS than by QCA: 0.50 +/- 0.52 mm before intervention (p < 0.0001), 0.46 +/- 0.45 mm after intervention (p < 0.0001), and 0.38 +/- 0.53 mm at follow-up (p < 0.0001). MLDs measured by IVUS were larger before intervention (0.17 +/- 0.28 mm, p < 0.0001), smaller after intervention (0.17 +/- 0.34 mm, p < 0.0001), and larger at follow-up (0.14 +/- 0.41 mm, p < 0.0001). This resulted in a smaller acute gain and late loss measured by IVUS (0.33 +/- 0.39 and 0.30 +/- 0.47 mm, respectively, both p < 0.0001). Although measures of restenosis (i.e., loss index and restenosis rates) were similar, the classification of lesions in individual patients (as restenotic vs nonrestenotic) was significantly different (p = 0.002, concordance rate = 73%). There are systematic differences between IVUS and QCA in the measurement of reference and lesion lumen dimensions. Although indexes of restenosis were similar, classification of lesions in individual patients was different. (C) 1997 by Excerpta Medico, Inc.