| Objective:Using optical coherent tomography(OCT),the lesions of patients with coronary heart disease acute coronary syndrome and stable angina patients were detected,and different treatment strategies were developed according to the nature and characteristics of the plaques to explore the application value of OCT in guiding individualized treatment in emergency PCI and selected PCI.Methods:A total of 101 patients admitted to the Department of Cardiology of the Second Affiliated Hospital of Kunming Medical University from January 2019 to May 2020 for emergency or elective coronary angiography and OCT were selected as the research subjects.Among them,32 cases were acute ST segment elevation myocardial infarction(STEMI),28 cases were acute non-ST segment elevation myocardial infarction(NSTEMI).17 cases were unstable angina(UA),and 24 cases were stable angina(SA).According to the results of OCT,the patients were redefined as stable plaque group(SP)and unstable plaque group(UP),including 54 cases in SP group and 47 cases in UP group.According to whether stent implantation is performed,it is divided into a stent implantation group and a non-stent implantation group,including 74 cases in the stent implantation group and 27 cases in the stentless implantation group.Collect general data,past history,body mass index,laboratory test indexes of the selected patients.The OCT system comes with software to analyze and measure the nature and characteristics of coronary plaques.SPSS23.0 statistical software was used to analyze the observation data,and the difference was judged to be statistically significant by P<0.05.Result:1.Among the selected patients,8.33%of patients with stable angina had unstable plaque,29.41%of patients with unstable angina had unstable plaque,53.57%of patients with NSTEMI had unstable plaque,and 100%of patients with STMEI had instability Plaque.2.The curvature of the lipid plaque in the unstable plaque group(272.50± 174.0)is greater than that in the stable plaque group(160.00 ± 72.90),the difference is statistically significant(P<0.01);the number of lipid plaques in the unstable plaque group(1.50 ± 2.0)greater than the stable plaque group(1.00 ± 0.00),the difference was statistically significant(P<0.01);the length of the lipid plaque(18.30±11.9)in the unstable plaque group was greater than the stable plaque group(10.00 ± 4.80),the difference was statistically significant(P<0.01);the minimum FCT of the unstable plaque group(59.96 ± 11.64)was smaller than that of the stable plaque group(100.00± 40.00),and the difference was statistically significant(P<0.01)35 cases with microchannels in plaque were found in unstable plaque group,accounting for 64.8%,20 cases with microchannels in plaque were found in stable plaque group,accounting for 42.6%,the difference was statistically significant(P<0.05);22 cases of calcified plaque in the unstable plaque group,accounting for 40.7%,31 cases of calcified plaque in the stable plaque group,accounting for 66.0%,the difference was statistically significant(P<0.01);28 in the unstable plaque group Thrombus was found in 51.9%of cases,macrophage infiltration was found in 3 cases,37.0%,intima erosion was found in 6 cases,11.1%,plaque rupture was found in 7 cases,accounting for 72.2%;none were found in the stable plaque group Thrombosis,macrophage infiltration,intimal erosion,plaque rupture,etc.,the proportions were not 0%,thedifference between the two groups was statistically significant(P<0.01).3.Among 32 cases of STEMI,28 cases were implanted with stents,accounting for 87.50%,4 cases without stents,accounting for 12.50%;28 cases of NSTEMI,24 cases with stents,accounting for 85.71%,4 cases without stents,14.29%;Of the 17 cases of unstable angina pectoris,14 cases were implanted with stents,accounting for 82.35%,3 cases without stents,accounting for 17.64%;24 cases of stable angina,8 cases with stents,33.33%,and 16 cases without stents,Accounting for 66.66%.4.The minimum lumen diameter of the stentless implant group(1.48 ± 0.54)was larger than that of the stented implant group(1.19± 0.37),the difference was statistically significant(P<0.05);the minimum lumen area of the stentless implant group(2.24 ± 1.36)greater than the stent-implanted group(1.38 ± 0.91),the difference was statistically significant(P<0.01);the percentage of area stenosis(62.21± 15.87)in the stent-free implanted group was smaller than that in the stented implant group(71.71±10.81),the difference is statistically significant(P<0.01);FCT(90.00 ± 40.75)in the stent-free implant group is greater than the stent implantation group(60.97 ± 34.01),the difference is statistically significant(p<0.05);no stent The curvature of lipid plaque in the implanted group(146.40 ± 111.40)was smaller than that in the stented group(186.40 ± 200),and the difference was statistically significant(P<0.01).5.The absolute value of lymphocytes(1.40±0.85)in unstable plaque group was lower than that in stable plaque group(1.78±0.86),the difference was statistically significant(P<0.05);lactate dehydrogenase,Alpha-hydroxybutyric acid,creatinine,homocysteine,white blood cell,neutrophil count,monocyte count and other indicators were higher than the stable plaque group,the difference was statistically significant(P<0.05);unstable plaque The NLR value of the block group(4.84± 4.81)was greater than that of the stable plaque group(2.62 ± 2.34),and the difference was statistically significant(P<0.01);the LMR value of the unstable plaque group(2.76 ±2.47)was smaller than that of the stable plaque group(4.45 ± 2.86),the difference was statistically significant(P<0.01);the MHR value of the unstable plaque group(0.51 ± 0.30)was greater than that of the stable plaque group(0.37 ± 0.26),and the difference was statistically significant(P<0.01).6.Plaque fiber cap thickness is negatively correlated with platelet/lymphocyte ratio(PLR)value(r=-0.574,p=0.000);plaque fiber cap thickness is negatively correlated with NLR value(r=-0.386,p=0.001);the lipid plaque arc is positively correlated with the PLR value(r=0.565,p=0.000);the lipid plaque arc is positively correlated with the NLR value(r=0.303,p=0.013).Conclusions:1.Under the guidance of OCT,some patients with acute coronary syndrome who have stable plaque and a small percentage of luminal stenosis area can take thrombus aspiration and/or intensive double antiplatelet therapy without stent implantation,which is personalized and accurate The treatment is of great significance to avoid unnecessary stent implantation.2.The minimum luminal area measured by OCT,the percentage of area stenosis,the radius of lipid plaque and other parameters provide an important reference for clinical decision whether to implant the stent.3.The values of PLR,NLR,MHR,and LMR may be related to plaque stability.The larger the PLR and NLR values,the thinner the fibrous plaque and the greater the curvature of lipid plaque.It can be used in primary hospitals without popular OCT testing equipment to provide a reference for the preliminary judgment of clinical coronary plaque stability. |
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