Application of optical coherence tomography in interventional diagnosis and treatment of coronary intermediate lesions / 中国综合临床

ABSTRACT

Objective:To explore the application of optical coherence tomography (OCT) in the interventional diagnosis and treatment of intermediate coronary disease.Methods:Patients were enrolled during January 2017 to January 2019, in the Department of Cardiology, the Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine.The patient whose diagnosis was confirmed as intermediate coronary artery lesion by coronary angiography then underwent coronary OCT examination.The general information, disease history, drug use, biochemical indicators and OCT imaging indicators were collected.Results:(1)A total of 75 borderline lesions were detected in 69 patients with coronary heart disease, including 52 cases of left anterior descending artery (LAD) (75.4%), 4 cases of left circumflex artery (5.8%, 4/69), and 19 cases (27.5%, 19/69) of right coronary artery (RCA). (2) According to the analysis of the plaque characteristics of borderline lesions OCT, 7 cases were accompanied with thrombosis, 6 cases with plaque rupture, 25 cases with thin fiber cap lipid plaque, 49 cases with macrophages, 35 cases with microvascular, 35 cases with cholesterol crystallization, 3 cases with ulcer and 6 cases with intimal dissection.(3)The median of the minimum lumen area (MLA) determined by OCT was 2.9 mm 2.In the MLA<2.9 mm 2 group, C-reactive protein (CRP) ((2.92±2.44) mg/L vs.(1.98±1.30) mg/L, P=0.045), total cholesterol (TC) ((4.13±0.78) mmol/L vs.(3.74±0.75) mmol/L, P=0.041), low density lipoprotein cholesterol ((2.77±0.83) mmol/L vs.(2.22±0.78) mmol/L, P=0.007), small and dense LDL ((1.02±0.44) mmol/L vs.(0.80±0.34) mmol/L, P=0.024), lipoprotein a ((1.16±0.17) mg/L vs.(0.95±0.09) mg/L, P=0.042) were significantly higher than those in MLA≥2.9 mm 2 group.(4). According to the interventional strategy, patients were divided into two groups percutaneous coronary intervention (PCI) group (N=16) and non-PCI group (N=59). The area stenosis (AS%) ((68.58±4.90)% vs.(63.10±7.09)%, P=0.001), diameter stenosis (DS%) ((65.65±6.91)% vs.(60.77±8.41)%, P=0.024), lipid plaque curvature ((245.3±41.0)° vs.(189.8±99.6)°, P=0.001), lipid plaque length ((19.11±6.40) mm vs.(14.72±9.30) mm, P=0.035) were deteriorated significantly in the PCI group than those in non-PCI group, the differences were all of them were statistically significant.(5)The incidence of 1-year major cardiovascular adverse events (MACE) was 6.25% in Oct guided PCI group and 5.08% in patients without PCI.There was no significant difference between the two groups ( P=0.317). Conclusion:According to the OCT assessment in the intermediate coronary lesions, it is found that the smaller the luminal area, the higher the serum LDL cholesterol level.More Interventional therapy were performed in the vulnerable plaques with large lipid cores.Decision-making for intermediate lesion was highly depended on the plaque tissue characteristics, rather than just MLA size.