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Clinical outcomes after percutaneous coronary intervention for in-stent chronic total occlusion.

支架内慢性完全闭塞经皮冠状动脉介入治疗后的临床结局。

  • 影响因子:2.41
  • DOI:10.4244/EIJ-D-19-00650
  • 作者列表:"Yoon YH","Lee PH","Lee SW","Kwon O","Lee K","Kang DY","Ahn JM","Park DW","Kang SJ","Kim YH","Lee CW","Park SW","Park SJ
  • 发表时间:2020-08-07
Abstract

AIMS:The aim of this study was to compare percutaneous coronary intervention (PCI) outcomes in relation to stent optimisation profiles between in-stent chronic total occlusions (CTOs) and de novo CTOs. METHODS AND RESULTS:We evaluated 1,516 consecutive patients who underwent PCI for 147 in-stent CTOs (9.3%) and 1,439 de novo CTOs between 2007 and 2018. The primary endpoint was target vessel failure (TVF) consisting of a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularisation. The final post-stenting intravascular ultrasound (IVUS) images were analysed. Target lesion complexity reflected by the Japanese CTO score was similar, albeit calcification was more prevalent in de novo CTOs, whereas occlusion length >20 mm was more frequent in in-stent CTOs. The technical success (88.4% vs 87.5%, p=0.84) and in-hospital adverse event (1.4% vs 3.6%, p=0.26) rates were similar between CTO types. Among those who received drug-eluting stents, the five-year TVF (11.0% vs 10.7%, p=0.99) and target vessel revascularisation (4.2% vs 3.7%, p=0.81) rates were similar between groups. Total stent length, minimum stent area (5.4±1.8 vs 5.5±1.8 mm2, p=0.77), and maximal plaque burden of the reference segments were largely comparable between groups. CONCLUSIONS:In-stent CTO PCI with drug-eluting stents optimised by IVUS guidance offers as acceptable long-term clinical results as those achieved in de novo CTOs.

摘要

目的: 本研究的目的是比较经皮冠状动脉介入治疗 (PCI) 结果与支架内慢性完全闭塞 (cto) 和从头cto之间的支架优化特征。 方法和结果: 我们评估了1,516例连续患者,这些患者在2007年至147年间接受了9.3% 次支架内cto (1,439) 和2018次从头cto。主要终点是由心脏死亡、靶血管相关心肌梗死或靶血管血运重建组成的靶血管衰竭 (TVF)。分析最终的支架置入后血管内超声 (IVUS) 图像。日本CTO评分反映的靶病变复杂性相似,尽管钙化在新生CTO中更常见,而闭塞长度> 20毫米在支架内CTO中更常见。技术成功率 (88.4% vs 87.5%,p = 0.84) 和院内不良事件 (1.4% vs 3.6%,p = 0.26) 在CTO类型之间相似。在接受药物洗脱支架的患者中,两组患者的5年TVF (11.0% vs 10.7%,p = 0.99) 和靶血管再血管化 (4.2% vs 3.7%,p = 0.81) 发生率相似。总支架长度、最小支架面积 (5.4 ± 1.8 vs 5.5 ± 1.8平方毫米,p = 0.77) 和参考节段的最大斑块负荷在组间基本相当。 结论: 采用IVUS指导优化的药物洗脱支架的支架内CTO PCI提供了与从头CTO获得的结果一样可接受的长期临床结果。

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影响因子:2.41
发表时间:2020-06-12
DOI:10.4244/EIJ-D-18-01138
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METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.

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影响因子:1.67
发表时间:2020-01-01
DOI:10.2174/1573403X15666190513105231
作者列表:["Dev M","Sharma M","Rana N"]

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心脏影像技术方向

心脏结构和心脏血流的可视化,用于诊断评估或通过内窥镜、放射性核素成像等技术来指导心脏手术。

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