摘要
目的血管内超声(IVUS)在冠状动脉临界病变诊疗中的价值已经得到广泛认可,但其多针对非心梗病变,而其对急性心肌梗死(AMI)临界病变患者意义如何,目前鲜有报道。本文拟探讨IVUS在ST段抬高型心肌梗死(STEMI)患者临界病变急诊经皮冠状动脉介入治疗中的应用价值,以期为该类患者的诊治提供一个更加合理的治疗方案。资料与方法前瞻性研究发病12 h内,冠状动脉造影(CAG)检查提示梗死相关动脉(IRA)固定狭窄为临界病变的STEMI患者68例,随机分为研究组33例和对照组35例。研究组采用IVUS指导,对照组采用CAG指导。对照组患者全部植入支架;研究组患者在CAG后行IVUS评估分为低危组和高危组。其中高危组全部植入支架,低危组给予药物治疗。比较两组患者术后1年心脏主要不良事件(MACE)发生率、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及支架植入数量。结果两组患者术后1年随访期间MACE发生率、LVEDD和LVEF比较,差异均无统计学意义(P>0.05);研究组植入支架12枚,对照组植入支架35枚,差异有统计学意义(P<0.05)。结论在对STEMI患者临界病变行急诊经皮冠状动脉介入治疗时,IVUS安全有效,减少了支架植入数量,为患者选择治疗方法提供一个更加合理的方案。
Purpose The value of intravascular ultrasound（IVUS） in diagnosis and treatment of intermediate coronary artery lesions has been widely recognized,but it mostly used for non-acute myocardial infarction（AMI） lesions,and rarely been reported in AMI lesions.The aim of this study is to explore the application of IVUS in the emergency percutaneous coronary intervention of the ST-elevation myocardial infarction（STEMI） patients with intermediate lesions,and to provide a more reasonable treatment options for the patients.Materials and Methods 1 Sixty-eight STEMI patients within 12 hours after symptom onset were enrolled prospectively and randomly assigned to the test group（33 patients） and the control group（35 patients）.All the patients had an intermediate fixed stenosis of infraction related artery（IRA） identified by CAG.IVUS guided was used in the test group and CAG guided was used in the control group.2 Stent implantation was performed in all control group patients.Test group patients were further divided into lowrisk and high-risk groups based on IVUS evaluation after CAG.Stent implantation was performed in all the high-risk patients,but low-risk group patients underwent medicine conservative treatment.Major adverse cardiac event（MACE） rates,changes in the left ventricular end-diastolic diameter（LVEDD）,left ventricular ejection fraction（LVEF） values,and stent numbers were compared between the two groups 1 year after surgery.Results There were no significant differences in the MACE rates,LVEDD,and LVEF values between the two groups at 1 year follow-up（P〉0.05）.Stents implantation performed less in the in test group（12 stents） than in the control group（35 stents）（P〈0.05）.Conclusion For the emergency PCI of STEMI critical lesions,IVUS may be a safe and feasible procedure with less stent implantation.It provides a more reasonable treatment option.
出处
《中国医学影像学杂志》
CSCD
北大核心
2016年第7期519-523,共5页
Chinese Journal of Medical Imaging
基金
河南省医学科技攻关计划项目(201204067)
关键词
心肌梗死
急性病
冠状血管造影术
超声检查
介入性
血管成形术
经腔
经皮冠状动脉
支架
Myocardial infarction
Acute disease
Coronary angiography
Ultrasonography
interventional
Angioplasty
transluminal
percutaneous coronary
Stents
