| Objectives:To analysis the baseline clinical data,laboratory biochemical indicators,the results of coronary angiography characteristics and the results of virtual histology intravascular ultrasound of previous coronary artery bypass grafting patients with recurrent angina who underwent intravascular ultrasound guided percutaneous coronary intervention for saphenous vein grafts in Tianjin Chest Hospital,we aimed to investigate risk factors and the predictive value of VH-IVUS of slow reflow/no-reflow phenomenon during percutaneous coronary intervention for culprit saphenous vein graft lesions,as well as to explore the predictive value of VH-IVUS in prognosing the patients with percutaneous coronary intervention for culprit saphenous vein graft lesions.Methods:We collected the baseline clinical data,the situation of previous CABG,the LVEF data as well as other UCG data and laboratory biochemical indicators of 32 previous coronary artery bypass grafting patients with recurrent angina who underwent intravascular ultrasound guided percutaneous coronary intervention for saphenous vein graft lesions with no less than 50% restenosis from April 2015 to September 2016 in Tianjin Chest Hospital.Before percuaneous coronary intervention procedure for culprit saphenous vein graft lesions,we collected the lumen crossarea,external elastic membrane crossarea and plaque burden of SVG lesions with highest restonsis degree detected by IVUS.By VH-IVUS,we collected the length,plaque volume of lesions,necrotic core volume,the percentage of necrotic core volume,dense calcium volume,the percentage of dense calcium volume,fibrotic volume,the percentage of fibrotic volume,fibro-fatty volume and the percentage of fibro-fatty volume of the whole culprit SVG lesion.At the same time,we collected necrotic core area,the percentage of necrotic core area,dense calcium area,the percentage of dense calcium area,fibrotic area,the percentage of fibrotic area,fibro-fatty area and the percentage of fibro-fatty area of SVG lesions with highest restonsis degree.By the result of Corrected TIMI Frame Count(CTFC)after PCI procedure,we divided the patients into slow reflow/no-reflow group(n=6)whose CTFC after PCI procedure was no more than 28 and normal reflow group(n=26)whose CTFC after PCI procedure was less than 28.By prospective analysis of these data,we aim to find the risk factors and the predictive value of VH-IVUS of no-reflow/slow-reflow phenomenon during percutaneous coronary intervention procedure for saphenous vein graft.Simultaneously,by analying the follow-up results,we aim to explore the predictive value of VH-IVUS in prognosing the patients with percutaneous coronary intervention for culprit saphenous vein graft lesions.Results:32 patients were included in the study,with 6 patients in slow reflow/no-reflow group and 26 patients in normal reflow group.By comparing the results of baseline clinical data,there was a significant difference in the level of systolic blood pressure(SBP: 136.92±19.75 vs.116.50±12.23,P<0.05)between normal reflow group and slow reflow/no-reflow group;by comparing the results of laboratory indicators,there were significant differences in the level of mean corpuscular volume(MCV: 94.25±9.20 vs.88.96±4.55,P<0.05),total cholesterol(TC: 4.79±0.89 vs.4.01±0.74,P<0.05)and high density lipoprotein cholesterol(HDL-C: 1.25±0.40 vs.0.98±0.23,P<0.05)between slow reflow/no-reflow group and normal reflow group.According to the result of linear regression analysis,the plaque burden of the culprit SVG lesions with highest restonsis degree was negetaively correlated with the percentage of fibrotic area(R2=0.234,P=0.005)and was positively correlated with the percentage of fibro-fatty area(R2=0.123,P=0.049);the plaque area of the culprit SVG lesions with highest restonsis degree was negetaively correlated with the percentage of fibrotic area(R2=0.192,P=0.012).By comparing the results of IVUS and VH-IVUS,there were significant differences of the length of lesions(79.43±48.68 vs.47.28±29.14,P<0.05),the percentage of necrotic core volume(23.12±10.09 vs.14.39±7.79,P<0.05),the percentage of dense calcium volume(7.33±4.66 vs.3.09±3.42,P<0.05),the percentage of fibrotic volume(58.82±6.53 vs.66.32±5.55,P<0.05),necrotic core area(2.07±1.57 vs.0.75±0.78,P<0.05),the percentage of necrotic core area(23.38±12.72 vs.12.52±10.86,P<0.05),dense calcium area(0.30±0.17 vs.0.07±0.13,P<0.05)and percentage of dense calcium area(3.85±2.18 vs.1.30±2.44,P<0.05)between slow reflow/no-reflow group and normal reflow group.Univariable Logistic regression analysis showed that the higher level of SBP [OR(95%CI): 1.093(1.007~1.186),P=0.033] and the percentage of fibrotic volume [OR(95%CI): 1.241(1.038~1.484),P=0.018] were protective factors of percutaneous coronary intervention procedure for saphenous vein graft.As well as the higher level of TC [OR(95%CI): 0.311(0.096~1.000),P=0.050],the percentage of necrotic core volume [OR(95%CI): 0.887(0.790~0.996),P=0.043],the percentage of dense calcium volume [OR(95%CI): 0.786(0.627 ~ 0.985),P=0.036],necrotic core area [OR(95%CI): 0.328(0.118~0.915),P=0.033] and dense calcium area [OR(95%CI): 0.000(0.000 ~ 0.120),P=0.008] were risk factors of percutaneous coronary intervention procedure for saphenous vein graft.After converting the set of correlated variables,including the percentage of fibrotic volume,the percentage of necrotic core volume,the percentage of dense calcium volume of the whole culprit SVG lesion,as well as the necrotic core area and the dense calcium area of SVG lesions with highest restonsis degree into a set of values named VH-IVUS influential factor,the multivariable Logistic regression showed that the VH-IVUS influential factor was the independent risk factor of percutaneous coronary intervention procedure for saphenous vein graft.The Kaplan-Meier survival curves and the Log-rank test showed that,at 6-month clinical follow-up,incidences of MACE-free survival rate,Fatal MI-free survival rate and Severe AP-free survival rate were higher in normal reflow group compared to slow-reflow/no-reflow group with no significant difference,while the Severe HF-free survival rate was significantly higher in normal reflow group compared to slow-reflow/no-reflow group.Univariable Cox regression showed that the higher level of the percentage of fibrotic volume [OR(95%CI): 0.832(0.706~0.980),P=0.028] was protective factor of incidence of MACE in prognosing the patients with percutaneous coronary intervention for culprit saphenous vein graft lesions.As well as the higher level of the percentage of necrotic core volume [OR(95%CI): 1.262(1.066~1.493),P=0.007] and necrotic core area [OR(95%CI): 3.201(1.396~7.336),P=0.006] were risk factors of incidence of MACE in prognosing the patients with percutaneous coronary intervention for culprit saphenous vein graft lesions.Multivariable Cox regression showed that the higher level of the percentage of necrotic core volume [OR(95%CI): 1.262(1.066 ~ 1.493),P=0.007] was the independent risk factor of incidence of MACE in prognosing the patients with percutaneous coronary intervention for culprit saphenous vein graft lesions.Conclusions:The plaque burden of the culprit SVG lesions with highest restonsis degree was negetaively correlated with the percentage of fibrotic area and was positively correlated with the percentage of fibro-fatty area;the plaque area of the culprit SVG lesions with highest restonsis degree was negetaively correlated with the percentage of fibrotic area.Univariable Logistic regression analysis showed that the higher level of SBP and the percentage of fibrotic volume were protective factors of percutaneous coronary intervention procedure for saphenous vein graft.As well as the higher level of TC,the percentage of necrotic core volume,the percentage of dense calcium volume,necrotic core area and dense calcium area were risk factors of percutaneous coronary intervention procedure for saphenous vein graft.The multivariable Logistic regression showed that the VH-IVUS influential factor was the independent risk factor of percutaneous coronary intervention procedure for saphenous vein graft.The Kaplan-Meier survival curves and the Log-rank test showed that,at 6-month clinical follow-up,incidences of MACE-free survival rate,Fatal MI-free survival rate and Severe AP-free survival rate were higher in normal reflow group compared to slow-reflow/no-reflow group with no significant difference,while the Severe HF-free survival rate was significantly higher in normal reflow group compared to slow-reflow/no-reflow group.Univariable Cox regression showed that the higher level of the percentage of fibrotic volume was protective factor,as well as the higher level of the percentage of necrotic core volume and necrotic core area were risk factors of incidence MACE in prognosing the patients with percutaneous coronary intervention for culprit saphenous vein graft lesions.Multivariable Cox regression showed that the higher level of the percentage of necrotic core volume was the independent risk factor of incidence of MACE in prognosing the patients with percutaneous coronary intervention for culprit saphenous vein graft lesions. |
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