Clinical Study On The Treatment Strategy Of NSTE-ACS Non-culprit Lesions Guided By Intravascular Ultrasound

Objective To observe the efficacy of intravascular ultrasound(IVUS)and coronary angiography(CAG)in the treatment of non-culprit lesions(NCL)in patients with non-ST-segment elevation acute coronary syndrome(NSTEACS)with multi-vessel disease.and to provide more precise and individualized treatment for NSTE-ACS patients,and to verify the effectiveness and feasibility of IVUS-guided percutaneous coronary intervention(PCI).Subject and Method:This study included 295 patients with NSTE-ACS,including non-ST-segment elevation myocardial infarction(NSTEMI)and unstable angina pectoris(UA),diagnosed in Tianjin chest Hospital from January 2016 to June 2018.All patients underwent CAG examination to confirm multi-vessel lesions,and all patients were treated with PCI for CL underwent percutaneous coronary intervention(PCI)for criminal lesions(CL).Patients were randomly divided into IVUS-guided treatment group(n=148)and CAG-guided treatment group(n=147).The IVUS group underwent gray-scale IVUS examination of NCL.Lesions with plaque burden(PB)≥70% were detected by PCI.Patients in CAG group with the diameter of NCL greater than 90% were performed for PCI,and all patients were given strict secondary prevention drug treatment.The baseline data(including age,sex,body mass index(BMI),diabetes mellitus,hypertension,family history,smoking history,admission biochemical examination),number of coronary artery lesions,number of stents implanted,hospitalization expenses,secondary preventive medication)were analyzed.Two groups of patients were followed up at 1,6,12,18,24 months after discharge by outpatient or telephone.The follow-up included: 1)the occurrence of major endpoint events,namely major adverse cardiovascular events(MACE),including non-fatal myocardial infarction,re-admission and revascularization therapy for severe angina pectoris symptoms,cardiogenic death and cardiac insufficiency.Secondary endpoint events: Seattle Angina Scale was used to quantify symptoms,functional status and disease-related quality of life after discharge.Results(1)There was no significant difference in baseline data between the two groups(P >0.05).(2)The stent implantation rate was significantly higher in the IVUS group than that of CAG group(P < 0.05),but the number of stent implantation was lower in IVUS group(P<0.05).(3)There was no significant difference in the average hospital cost between the two groups(P>0.05).(4)The follow-up showed that there was no significant difference in MACE incidence between the two groups(5.52% vs.1.37%,χ2=2.589,P>0.05).The degree of physical activity limitation,angina pectoris frequency,and disease cognition score were significantly better in the IVUS group than those of the CAG group(P<0.05).The Kaplan-Meier curve was used to compare the event-free survival time of the two groups,and there was no significant difference between the two groups(94.5% vs.98.6%,Log-rank 2χ =3.276,P>0.05).Conclusion IVUS guidance NCL treatment can reduce the average number of stent implantation,optimize stent implantation,not increase costs in treatment,and improve the quality of life.