Objective: To compare the 6-month follow-up results of primary percutaneous coronary intervention (PPCI) guided by optical coherence tomography (OCT) or coronary angiography (CAG) alone in a larger ST-segment elevation myocardial infarction (STEMI) cohort. Methods: We enrolled 275 STEMI patients undergoing OCT-guided PPCI from March 2017 through December 2018. Two hundred and seventy-five propensity score matched STEMI patients undergoing CAG-guided PPCI served as control group. The 6-month clinical follow-up results were compared between the two groups. The demographic data, complications, coronary angiography and OCT characteristics were evaluated. Results: OCT evaluation showed that there were 151 patients (54.9%) with plaque prolapse and 113 patients (41.1%) with stent malposition. Proximal and/or distal dissection of stents occurred in 38 patients (13.8%), of which 3 patients (1.1%) had both proximal and distal dissection. Of the 38 patients, 2 patients received rescue stent implantation. Results of clinical follow-up at 6 months showed that there was no significant difference in cardiovascular death, repeat myocardial infarction, target vessel revascularization, stroke and hemorrhage endpoint events between OCT-guided PPCI patients and CAG-guided PPCI patients (P=0.682). Conclusion: Clinical events at 6 months are similar between OCT-guided PPCI and CAG-guided PPCI for STEMI patients.
目的： 比较光学相干断层成像（OCT）指导和单纯冠状动脉造影（CAG）指导直接冠状动脉介入治疗（PPCI）6个月的随访结果。 方法： 前瞻性研究。连续入选2017年3月至2018年12月阜外医院因ST段抬高型心肌梗死（STEMI）行OCT指导的PPCI患者275例（OCT指导组）。收集全部入选患者的人口学资料、合并疾病、冠状动脉造影和OCT特征资料。采用倾向性评分从单纯CAG指导的PPCI患者数据库中1∶1回顾性顺序匹配275例患者（CAG指导组），对比两种策略对6个月临床随访结果的影响。 结果： OCT指导组中，OCT评估发现斑块脱垂151例（54.9%），支架贴壁不良113例（41.1%），支架近和/或远端夹层38例（13.8%），其中3例（1.1%）同时发生支架近端和远端夹层，38例远端夹层患者中，需行补救性置入支架2例。随访6个月结果显示，OCT指导组与CAG指导组比较，心血管死亡、再次心肌梗死、靶血管再次血运重建、卒中和出血终点事件差异均无统计学意义（P=0.682）。 结论： 与单纯CAG指导相比，OCT指导的PPCI并不能降低6个月的临床终点事件。.
Keywords: Myocardial infarction; Optical coherence tomography; Percutaneous coronary intervention; Prognosis.