RESULTS: Patients with CCS who underwent pre- and post-PCI S-TDE and elective fractional flow reserve (FFR)-guided PCI under OCT guidance for de novo single LAD lesions were included. S-TDE-derived hyperemic diastolic peak flow velocity (hDPV) was used as a surrogate for coronary flow. Lesions were categorized into two groups based on the %hDPV increase or decrease. The baseline clinical, physiological, and OCT findings were compared between the groups. In total, 103 LAD lesions were studied in 103 patients. After PCI, hDPV significantly increased from 55.6 cm/s to 69.5 cm/s (P<0.01), with a median %hDPV increase of 27.2 (6.32-59.1) %, while %hDPV decreased in 20 (19.4%) patients. The FFR improved in all patients. On OCT, layered plaques were more frequently present in the culprit vessels in the %hDPV-decrease group than in the %hDPV-increase group (85.0% vs. 50.6%, P = 0.01). Multivariable logistic regression analysis showed that the presence of layered plaques and high pre-PCI hDPV were independent predictors of %hDPV decrease.
CONCLUSIONS: In patients who underwent successful uncomplicated elective PCI for de novo single LAD lesions, the presence of layered plaques was independently associated with hyperemic coronary flow decrease as assessed by S-TDE.
结果:纳入在OCT指导下接受PCI术前和术后S-TDE和选择性血流储备分数(FFR)引导PCI的CCS患者,以治疗新的单个LAD病变。S-TDE衍生的充血舒张峰值流速(hDPV)用作冠状动脉血流的替代指标。根据%hDPV增加或减少将病变分为两组。基线临床,生理,比较各组间的OCT结果.总的来说,在103例患者中研究了103例LAD病变。PCI术后hDPV从55.6cm/s显著升高至69.5cm/s(P<0.01),hDPV中位数增加27.2(6.32-59.1)%,而20例(19.4%)患者的%hDPV下降。所有患者的FFR均得到改善。在OCT上,与%hDPV增加组相比,%hDPV降低组的罪魁祸首血管中存在分层斑块的频率更高(85.0%vs.50.6%,P=0.01)。多变量logistic回归分析显示,分层斑块的存在和PCI前hDPV升高是hDPV降低的独立预测因子。
结论:在接受了从头单个LAD病变的无并发症择期PCI成功的患者中,通过S-TDE评估,分层斑块的存在与冠状动脉血流充血减少独立相关.