| Background:According to the 2011 report of the World Health Organization,the number of deaths from coronary heart disease in China has ranked second in the world.According to the 2016 China Health and Family Planning Statistical Yearbook,the death rate of coronary heart disease in Chinese urban residents was 110.67/100,000 in 2015,and the mortality rate of coronary heart disease in rural residents was 110.91/100,000,compared with the previous year(110.5/100,000,105.37/100,000)compared to a slight increase.Overall,the prevalence and mortality of cardiovascular disease in China is still on the rise,and the number of cardiovascular patients will continue to grow rapidly in the next 10 years.Cardiovascular disease management and intervention costs are high,accounting for 25% of the total medical cost.Therefore,the prevention and treatment of coronary heart disease has become a top priority.According to the data from the National Health and Family Planning Commission’s PCI network,there were 567,583 cases of coronary heart disease intervention in the mainland in 2015.In China,an average of 426.82 patients per million population undergo percutaneous coronary intervention.The mortality rate of interventional therapy is stable at a low level.With the extensive development of interventional procedures,simple coronary angiography can not meet the needs of guiding interventional surgery.The main pathogenesis of acute coronary events is rupture of vulnerable plaques and secondary thrombosis.At present,coronary angiography,intravascular ultrasound and angioscopy are commonly used in clinical practice to identify vulnerable plaques.However,due to the low resolution,these tests cannot identify vulnerable plaques in advance to prevent the occurrence of acute coronary syndrome.Optical coherence tomography(OCT)has an extremely high resolution of 10×20 μm,which can clearly analyze the organ structure and is the best examination for identifying vulnerable plaque.It is called “photobiopsy”.Objective:At present,the clinical application of OCT is still controversial.The purpose of this analysis is to evaluate the effect of OCT by studying the clinical prognosis of patients with OCT guidance.Method:Retrospective analysis of 600 patients who underwent OCT examinations in our hospital from April 16,2014 to November 17,2017,collected their general clinical data,coronary angiography records,and OCT findings,summarizing OCT in coronary heart disease The application of the patient,such as the guidance of the critical lesion surgical strategy,intraoperative malapposition,dissection,thrombosis,plaque rupture,etc.,patients with a left anterior descending coronary artery,a left circumflex artery,and a right coronary artery with a minimum lumen cross-sectional area between [3,4)were divided into two groups according to the presence or absence of interventional therapy.By comparing their prognosis,it was necessary to explore whether patients within the range needed interventional therapy.Follow-up of patients with cardiovascular adverse events by telephone,the primary end point was major adverse cardiac events(MACE),including myocardial infarction(MI),target lesion revascularization(TLR),and cardiac death.Secondary study endpoints included The angina pectoris,rehospitalization and heart failure,etc.,to determine the prognosis,to assess the advantages and disadvantages of OCT-guided treatment,optimize the surgical strategy.Result:1.Of the 600 patients with all-cause deaths,19(3.2%),9(1.5%)were cardiogenic deaths,3 were unexplained,and 7 were non-cardiac deaths.Seven patients(1.2%)had myocardial infarction and 18(3%)underwent revascularization.There were 248 cases(41.3%)with angina pectoris,115 cases(19.2%)with re-hospitalization,and 20 cases(3.3%)with heart failure.2.411 patients with OCT guided PCI underwent myocardial infarction in 5 patients(1.2%),cardiogenic death in 5 patients(1.2%),revascularization in 14 patients(3.2%),and recurrent angina pectoris in 172 patients(41.8%).89 patients(21.7%)were hospitalized and 16 patients(3.9%)had heart failure.3.40.9% of patients with critical lesions(50%-70% angiographic stenosis)changed their surgical strategy and required interventional therapy.4.When the minimum lumen cross-sectional area of the left anterior descending coronary artery,the left circumflex artery,and the right coronary artery was measured by OCT is between [3,4),there was no significant difference in cardiovascular adverse events between interventional therapy and non-interventional therapy.(P>0.05).Conclusions:1.When the minimum lumen cross-sectional area of the left anterior descending coronary artery,the left circumflex artery,and the right coronary artery was measured by OCT between [3,4),there was no significant difference in the prognosis between interventional therapy and non-interventional therapy.The lumen area of 4mm2 is not the only indicator of interventional therapy.2.OCT changes the surgical strategy of patients with 40.9% of critical lesions. |
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