BACKGROUND:Our objective was to compare the efficacy and safety of a drug-eluting stent featuring an abluminal bioabsorbable sirolimus-containing polymer coating (BP-SES) with an everolimus-eluting stent with a durable polymer (DP-EES) in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). METHODS:TARGET CTO is a multicenter, open-label, noninferiority trial that randomized patients to either BP-SES or DP-EES in a 1:1 fashion following successful CTO re-canalization. The primary endpoint that was powered for noninferiority assessment is in-stent late lumen loss (LLL) at 12 months. RESULTS:A total of 206 subjects underwent randomization, with 103 assigned to the BP-SES group and 103 to the DP-EES group. Baseline clinical and angiographic characteristics were comparable. The primary endpoint demonstrated noninferiority for the BP-SES group compared to the DP-EES group (0.21 ± 0.43 mm vs 0.21 ± 0.33 mm; P = .934, 2-sided; difference 0.01mm [BP-SES minus DP-EES]; 95% CI: -0.13 to 0.12 mm; p noninferiority < .001,1-sided). No significant differences were observed in secondary angiographic or clinical endpoints. The rates of 12-month in-stent and in-segment binary restenosis in the BP-SES group and the DP-EES group were similar (6.8% vs 7.5%, P = .86; and 8.1% vs 8.8%; P = .89, respectively). Although there was a trend favoring the BP-SES group, the difference between the BP-SES group and DP-EES group at 12 months in target lesion failure (2.1% vs 8.0%, P = .054) and target lesion revascularization (2.1% vs 7.1%, P = .089) did not reach statistical significance. No definite or probable stent thromboses were reported in either group. CONCLUSIONS:Compared to DP-EES, PCI of CTOs with BP-SES showed similar results in terms of late loss and binary restenosis at the 12-month follow-up. CLINICAL TRIAL:ClinictalTrial.gov, number NCT03040934.

Background: Studies reporting the status of coronary microvascular function in the infarct-related artery (IRA) after primary percutaneous coronary intervention (PCI) remain limited. This study utilized the coronary angiography-derived index of microcirculatory resistance (caIMR) to assess coronary microvascular function in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI. Methods: We used the FlashAngio system to measure the caIMR after primary PCI in 157 patients with STEMI. The primary endpoint was the occurrence of a major adverse cardiovascular event (MACE), defined as a composite endpoint encompassing cardiac mortality, target vessel revascularization, and rehospitalization due to congestive heart failure (CHF), myocardial infarction (MI), or angina. Results: Approximately 30% of patients diagnosed with STEMI and who experienced successful primary PCI during the study period had a caIMR in the IRA of >40. The caIMR in the IRA was significantly higher than in the reference vessel (32.9 ± 15.8 vs. 27.4 ± 11.1, p < 0.001). The caIMR in the reference vessel of the caIMR >40 group was greater than in the caIMR ≤40 group (30.9 ± 11.3 vs. 25.9 ± 10.7, p = 0.009). Moreover, the caIMR >40 group had higher incidence rates of MACEs at 3 months (25.5% vs. 8.3%, p = 0.009) and 1 year (29.8% vs. 13.9%, p = 0.04), than in the caIMR ≤40 group, which were mainly driven by a higher rate of rehospitalization due to CHF, MI, or angina. A caIMR in the IRA of >40 was an independent predictor of a MACE at 3 months (hazard ratio (HR): 3.459, 95% confidence interval (CI): 1.363–8.779, p = 0.009) and 1 year (HR: 2.384, 95% CI: 1.100–5.166, p = 0.03) in patients with STEMI after primary PCI. Conclusions: Patients with STEMI after primary PCI often have coronary microvascular dysfunction, which is indicated by an increased caIMR in the IRA. An elevated caIMR of >40 in the IRA was associated with an increased risk of adverse outcomes in STEMI patients undergoing primary PCI.

AbstractObjectivesPatients undergoing a prior failed attempt of chronic total occlusion‐percutaneous coronary intervention (CTO‐PCI) represent a challenging subgroup across all patients undergoing CTO‐PCI. There are limited data on the effects of a prior failed attempt on the outcomes of subsequent CTO‐PCI. We aimed to compare the procedural results and 24‐month outcomes of prior‐failed‐attempt CTO‐PCI with those of initial‐attempt CTO‐PCI.MethodsPatients who underwent attempted CTO‐PCI between January 2017 and December 2019 were prospectively enrolled. We analyzed the procedural results and 24‐month major adverse cardiac events (MACE) between patients who underwent prior‐failed‐attempt and initial‐attempt CTO‐PCI. MACE was defined as a composite of cardiac death, target vessel‐related myocardial infarction, and ischemia‐driven target vessel revascularization (TVR) during follow‐up.ResultsIn total, 484 patients who underwent CTO‐PCI (prior‐failed‐attempt, n = 49; initial‐attempt, n = 435) were enrolled during the study period. After propensity score matching (1:3), 147 patients were included in the initial‐attempt group. The proportion of the Japanese‐CTO (J‐CTO) score ≥2 was higher in the patients who underwent prior failed attempt than in those who underwent initial attempt (77.5% vs. 38.8%, p < 0.001). The retrograde approach was more often adopted in the prior‐failed‐attempt group than in the initial‐attempt group (32.7% vs. 3.4%, [P< 0.001). Successful CTO revascularization rates were significantly lower in the prior‐failed attempt‐group than in the initial attempt group (53.1% vs. 83.3%, P < 0.001). The multivariate analysis revealed that J‐CTO score ≥2 [odds ratio (OR), 0.359; 95% confidence interval (CI), 0.159–0.812; P = 0.014], intravascular ultrasound procedure (OR, 4.640; 95% CI, 1.380–15.603; P = 0.013), and prior failed attempt (OR, 0.285; 95% CI, 0.125–0.648; P = 0.003) were the independent predictors for successful CTO revascularization. There were no significant differences in major procedural complications (2.0% vs. 0.7%, p = 0.438) and MACE rates (4.1% vs. 8.8%, p = 0.438) between the groups, mainly due to the TVR rate (4.1% vs. 8.2%, P = 0.522).ConclusionsCompared with initial‐attempt CTO‐PCI, prior‐failed‐attempt CTO‐PCI deserves more attention, since it is associated with a lower successful CTO revascularization rate. Prior failed attempt, J‐CTO score ≥2, and IVUS procedure are the determining factors for predicting successful CTO revascularization. There are no significantly different unfavorable outcomes between patients who undergo prior‐failed‐attempt and initial‐attempt CTO‐PCI.

BackgroundRotational atherectomy (RA) remains an integral tool for the treatment of severe coronary calcified lesions despite emergence of newer techniques. We aimed to evaluate the contemporary clinical practices and outcomes of RA in China.MethodsThe Rota China Registry (NCT03806621) was an investigator-initiated, prospective, multicenter registry based on China Rota Elite Group. Consecutive patients treated with RA were recruited. A pre-designed, standardized protocol was recommended for the RA procedure. The primary safety endpoint was major adverse cardiovascular events (MACE: composite of cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) at 30 days. The primary efficacy endpoint was procedural success.ResultsBetween July 2018 and December 2020, 980 patients were enrolled at 19 sites in China. Mean patient age was 68.4 years, and 61.4% were men. Radial access was used in 79.1% patients, and 32.7% procedures were guided by intravascular imaging. A total of 22.6% procedures used more than 1 burr, and the maximal burr size was >= 1.75 mm in 24.4% cases, with burr upsizing in 19.3% cases, achieving a final burr-to-artery ratio of 0.52. Procedural success was achieved in 91.1% of patients, and the rate of 30-day and 1-year MACE was 4.9% and 8.2%, respectively. Multivariable analysis identified the total lesion length (HR 1.014, 95% CI: 1.002-1.027; p = 0.021) as predictor of 30-day MACE, and renal insufficiency (HR 1.916, 95% CI: 1.073-3.420; p = 0.028) as predictor of 1-year MACE.ConclusionsIn this contemporary prospective registry in China, the use of RA was effective in achieving high procedural success rate with good short- and long-term outcomes in patients with severely calcified lesions.

Purpose:Coronary angiography-derived fractional flow reserve (caFFR) is a novel computational flow dynamics (CFD)-derived assessment of coronary vessel flow with good diagnostic performance. Herein, we performed a retrospective study to evaluate the reproducibility of caFFR findings between observers and investigate the diagnostic performance of caFFR for coronary stenosis defined as FFR ≤0.80, especially in the grey zone (0.75≤caFFR ≤0.80). Patients and Methods:A total of 150 patients (167 coronary vessels) underwent caFFR (with FlashAngio used for calculation of flow variables) and subsequent invasive fractional flow reserve (FFR) measurements. Outcomes, including reproducibility, were compared for vessels in and outside the grey zone. Results:The correlation of caFFR findings was good between the two laboratories (r = 0.723, p<0.001). The AUC of ROC were both high for caFFR-CoreLab1 and caFFR-CoreLab2 (0.975 and 0.883). The diagnostic accuracy, sensitivity, specificity, and negative and positive predictive values were not significantly different between the two laboratories (p>0.05). caFFR had a strong correlation with measures to FFR (r=0.911, p<0.001). There was no systematic difference between caFFR and FFR on Bland-Altman analysis in and outside the grey zone. There was no difference in diagnostic accuracy between the grey and non-grey zones in the prediction of FFR ≤0.80 (p=0.09). Conclusion:The inter-observer reproducibility for caFFR was high, and the diagnostic accuracy of caFFR was good compared to that of FFR.

目的:验证冠状动脉造影血流储备分数(caFFR)在灰区的诊断准确度及其测量可重复性.方法:回顾性纳入进行经导丝血流储备分数(FFR)测定的冠心病患者150例,按照FFR的不同,分为灰区(FFR 0.75～0.80)组(n=55)及非灰区(FFR<0.75或FFR>0.80)组(n=95).由2名操作者独立使用FlashAngio系统进行caFFR离线测定.利用Pearson相关系数分析FFR与caFFR的相关性,Bland-Altman图示法分析FFR与caFFR的一致性以及2名操作者间的测量变异度,利用准确度、灵敏度、特异度等评价caFFR的诊断价值.结果:回顾性测量的caFFR与导丝FFR相关性(r=0.870,P<0.001)及一致性良好(差值均值为0.00,95％一致限:-0.08～0.09).caFFR在灰区的诊断准确度稍有下降,但与非灰区相比差异无统计学意义(85.7％vs.93.7％,P=0.089).caFFR在不同操作者间的测量可重复性良好,平均差值为0.00(95％一致限:-0.12～0.13).结论:caFFR在灰区的诊断准确度及不同观察者间测量一致性较好.

Background: There are scarce published data reporting the effect of rotational atherectomy (RA) on coronary microcirculation function. Objectives: We aimed to evaluate coronary microcirculation function indicated by the coronary angiography-derived index of microvascular resistance (caIMR) in patients undergoing RA. Methods: RA procedures between January 2013 and December 2021 were retrospectively analyzed. We investigated coronary microcirculation function indicated by caIMR as well as peri-procedural adverse events among the study population. All caIMR measurements were performed using a FlashAngio system. The primary outcome was a composite of post-RA thrombolysis in myocardial infarction (TIMI) flow grade <3 in the target vessel, myocardial injury, procedure-related myocardial infarction, and cardiac death during hospitalization. Results: A total of 155 RA procedures were analyzed. The post-RA caIMRs were significantly higher than pre-RA caIMRs in the target vessels (16.0 ± 7.0 vs. 14.5 ± 7.5, p = 0.029). Patients with post-RA caIMR ≥25 accounted for nearly 12% of those with pre-RA caIMR <25. Patients with post-RA thrombolysis in myocardial infarction (TIMI) flow grade <3 had a significantly higher pre-RA caIMR (23.5 ± 10.2 vs. 13.7 ± 6.6, p = 0.005), and the proportion of patients with pre-RA caIMR ≥25 in the group with TIMI flow grade <3 was greater (61.5% vs. 38.5%, p < 0.001) than that in the group with TIMI flow grade of 3. Maximum RA time of each pass (odds ratio: 1.127, 95% confidence interval: 1.025–1.239, p = 0.014) and pre-RA caIMR ≥25 (odds ratio: 3.254, 95% confidence interval: 1.054–10.048, p = 0.040) were identified to be the independent predictors of the primary outcome for patients who underwent RA. Conclusions: There were significant changes in the coronary microcirculation function of the target vessels after receiving RA as indicated by increased post-RA caIMR compared to pre-RA caIMR. Patients with baseline coronary microcirculatory dysfunction were more likely to have post-RA TIMI flow grade <3, whereas those with pre-RA caIMR ≥25 experienced worse outcomes.

目的 分析经皮冠状动脉介入(PCI)开通慢性完全闭塞(CTO)病变对左室心肌灌注和收缩同步性的影响.方法 登记2017年1月至2019年12月在北京医院对CTO病变行PCI治疗的312例患者,其中36例于CTO病变开通前及开通12个月后均进行了门控心肌灌注显像(G-MPI)检查纳入本研究.采用配对或独立样本t检验及Wilcoxon秩和检验的方法比较PCI开通CTO病变前后负荷总积分(SSS)、静息总积分(SRS)、差值总积分(SDS)、灌注可逆性节段数(RS)、灌注不可逆节段数(NRS)、心肌总灌注缺损范围(TPD)、左心室射血分数(LVEF)以及静息和负荷的相位直方图带宽(PBW)和相位标准差(PSD)等指标,用Pearson线性相关分析LVEF与PBW和PSD的关系.结果 36例患者CTO病变开通后,SSS(7.2±7.9比10.8±6.9,t=3.612,P=0.001)、SRS(4.4±6.3比5.9±5.9,t=2.721,P=0.010)和SDS(2.8±3.1比4.7±4.0,t=2.727,P=0.010)均较开通前显著降低,RS(1.9±1.9比3.5±2.1,t=3.843,P=0.001)和负荷TPD(10.0％±11.1％比14.7％±10.0％,t=3.838,P=0.001)也较开通前明显减少.在心肌收缩同步性参数中,负荷PBW[(66.7±26.8)°比(83.1±33.0)°,t=3.365,P=0.002]和PSD[(18.3±6.9)°比(22.8±9.7)°,t=2.972,P=0.005]较开通前显著降低.无论是CTO病变开通前还是开通后,LVEF与静息或负荷状态下的PBW和PSD均呈显著负相关,并且LVEF≥50％患者的静息PBW、PSD和负荷PBW、PSD均显著低于LVEF<50％者(均为P<0.05).结论 CTO病变经PCI开通后心肌可逆性缺血和负荷状态下的心肌收缩同步性可得到改善,LVEF与心肌收缩同步性指标呈负相关,高LVEF的CTO患者的心肌收缩同步性更好.

Background:Treatment of chronic total occlusions (CTOs) is referred to as the last frontier of percutaneous coronary interventions and is currently performed in 10% to 20% of procedures. Improved outcomes with newer generation drug-eluting stents require further research. Methods:The TARGET CTO trial (NCT03040934) is a prospective, multicenter, randomized, noninferiority trial that plans to randomize 196 subjects (1:1) to either a newer-generation sirolimus target-eluting stent or an everolimus-eluting stent. Patients are candidates if they present with at least 1 CTO lesion in a native coronary artery with a diameter of ≥2.50 mm to ≤4.00 mm and a length of <100 mm. In addition, 44 subjects will participate in an optical coherence tomography (OCT) substudy. Clinical follow-up is planned up to 5 years after stent implantation. Angiographic follow-up is planned at 12 months, whereas OCT will be obtained after the procedure, at 3 and 12 months. The primary end point is in-stent late lumen loss by quantitative coronary angiography at 12 months. The key secondary end point is neointimal thickness by OCT at 3 months. Imaging end points are assessed by an independent core lab. Clinical end points are adjudicated by an independent clinical events committee. Conclusion:The TARGET CTO trial compares a sirolimus target-eluting stent with an everolimus-eluting stent for management of CTOs according to contemporary interventional practices. The primary angiographic end points will be reported at 12 months and clinical follow-up will continue for up to 5 years.

Objective:To evaluate the diagnostic value of coronary angiography-based fractional flow reserve(caFFR)versus a wire-based fractional flow reserve(FFR)in elderly patients with stable ischemic heart disease.Methods:A total of 168 patients(186 vessels)who underwent a pressure wire(PW)-based FFR measurement from Jan.2015 to Dec.2019 in Beijing hospital were enrolled and analyzed retrospectively.Coronary angiography images and matched steady-state aortic pressure of patients were sent to the core laboratory for caFFR measurement under the blind method.All patients were divided into the non-elderly group(<65 years, n=93)and the elderly group(≥65 years, n=75). The diagnostic value of caFFR was evaluated by using the wire-based FFR cut-off value of ≤0.80 as the reference standard.The correlation and consistency of caFFR and wire-based FFR were analyzed, and compared between the non-elderly and elderly groups.Results:The caFFR had a good correlation and consistency with wire-based FFR in the elderly group( r=0.796, P<0.01). In non-aged versus elderly groups, diagnostic accuracy of caFFR was 91.9% versus 93.1%, diagnostic sensitivity of caFFR was 91.8% vs.93.2%, diagnostic specificity of caFFR was 92.3% vs.93.0%, all P>0.05.The area under the receiver-operating characteristic curve of caFFR had no significant difference between the non-elderly and elderly patients(0.964 vs.0.972, Z=0.00823, 95% CI: -0.037-0.052, P>0.05). Conclusions:The caFFR has a good diagnostic correlation and consistency with wire-based FFR in the elderly group, and caFFR's diagnostic performance in the elderly is similar to that in the non-elderly patients.

Background Delayed coronary artery occlusion (CAO) is a rare but fatal complication after transcatheter aortic valve replacement, chimney stenting is the standard technique for established CAO or impending CAO. Case presentation We describe a female patient who developed non-ST elevation myocardial infarction after receiving transcatheter aortic valve replacement and chimney stenting 4 months prior. An angiogram revealed delayed coronary artery occlusion with a deformed stent, which was never reported. This patient was subsequently treated with a new chimney stent. Conclusions For self-expanding valves, the coronary ostium is protected by chimney stenting, delayed coronary artery occlusion can occur and cause catastrophic complications.

Background In-stent restenosis (ISR) chronic total occlusion (CTO) represents a challenging subgroup for revascularization of CTO by percutaneous coronary intervention (PCI). There are limited data on the treatment and outcomes of PCI for ISR CTO. Objective We aimed to evaluate the procedural results and 2-year outcomes of PCI for ISR CTO compared with de novo CTO. Methods Patients undergoing attempted CTO PCI between January 2017 and December 2019 were prospectively enrolled. We analyzed the procedural results and 2-year major adverse cardiac events (MACE) in patients undergoing ISR CTO and those undergoing de novo CTO PCI. Results A total of 426 patients undergoing 484 consecutive CTO PCI (ISR CTO PCI, n=84; de novo CTO, n=400) were enrolled during the study period. Patients undergoing de novo CTO PCI had a significantly greater syntax score than those undergoing ISR CTO PCI [23.0 (17.5, 30.5) vs 21.5 (14.5, 27.0), p=0.039]. Technical (73.8% vs 79.0%, p=0.296) and procedural (73.8% vs 78.0, p=0.405) success rates, as well as the incidence of major procedural complications (1.2% vs 2.3%, p=0.842), were comparable between the two groups. After a median follow-up of 20 months, patients who underwent ISR CTO PCI had a significantly higher incidence of MACE (33.3% vs 10.3%, p<0.001), mainly attributed to the higher TVR rates (24.7% vs 7.6%, p<0.001). ISR CTO was the only independent predictor of MACE (hazard ratio, 4.124; 95% confidence interval, 1.951–8.717; p<0.001) during follow-up in patients who underwent CTO PCI. Conclusion ISR CTO PCI shows comparable technical and procedural success, as well as major procedural complications compared with de novo CTO PCI. However, patients who underwent ISR CTO PCI had a significantly worse prognosis than those who underwent de novo CTO PCI, in terms of MACE, driven by TVR. ISR CTO was the only independent predictor of MACE during the follow-up.

家族性高胆固醇血症(FH)因其血脂水平明显增高,引发动脉粥样硬化及心血管事件.前蛋白转化酶枯草溶菌素9(PCSK9)可通过诱导低密度脂蛋白受体内化降解来调节低密度脂蛋白胆固醇(LDL-C)代谢.PCSK9抑制剂通过调节PCSK9水平使LDL-C显著降低,从而为FH患者带来获益.

冠心病严重影响我国居民健康。冠状动脉造影可以明确是否存在冠状动脉粥样硬化狭窄，但无法准确地判定狭窄是否引起心肌缺血。血流储备分数是目前使用最广泛的冠状动脉生理学评价指标，能识别引起心肌缺血的冠状动脉狭窄病变。血流储备分数的相关衍生指标相继出现，简化了血流储备分数的测量过程，有助于推广冠状动脉生理功能评价指标在临床中的应用。本文将对冠状动脉血流储备分数衍生指标的原理、研究证据及优缺点做出总结梳理。.

Background: Coronary angiography-derived fractional flow reserve (caFFR) measurements have shown good correlations and agreement with invasive wire-based fractional flow reserve (FFR) measurements. However, few studies have examined the diagnostic performance of caFFR measurements before and after percutaneous coronary intervention (PCI). This study sought to compare the diagnostic performance of caFFR measurements against wire-based FFR measurements in patients before and after PCI.Methods: Patients who underwent FFR-guided PCI were eligible for the acquisition of caFFR measurements. Offline caFFR measurements were performed by blinded hospital operators in a core laboratory. The primary endpoint was the vessel-oriented composite endpoint (VOCE), defined as a composite of vessel-related cardiovascular death, vessel-related myocardial infarction, and target vessel revascularization.Results: A total of 105 pre-PCI caFFR measurements and 65 post-PCI caFFR measurements were compared against available wire-based FFR measurements. A strong linear correlation was found between wire-based FFR and caFFR measurements (r = 0.77; p < 0.001) before PCI, and caFFR measurements also showed a high correlation (r = 0.82; p < 0.001) with wire-based FFR measurements after PCI. A total of 6 VOCEs were observed in 61 patients during follow-up. Post-PCI FFR values (≤0.82) in the target vessel was the strongest predictor of VOCE [hazard ratio (HR): 5.59; 95% confidence interval (CI): 1.12–27.96; p = 0.036). Similarly, patients with low post-PCI caFFR values (≤0.83) showed an 8-fold higher risk of VOCE than those with high post-PCI caFFR values (>0.83; HR: 8.83; 95% CI: 1.46–53.44; p = 0.017).Conclusion: The study showed that the caFFR measurements were well-correlated and in agreement with invasive wire-based FFR measurements before and after PCI. Similar to wire-based FFR measurements, post-PCI caFFR measurements can be used to identify patients with a higher risk for adverse events associated with PCI.

Purpose: Renal artery stenosis leads to ischemic renal insufficiency, but methods for assessing renal perfusion are limited. This study aimed to evaluate the association between renal slow perfusion and impaired renal function in atherosclerotic renal artery stenosis (ARAS). Patients and Methods: A total of 79 consecutive patients with uncontrolled hypertension who underwent renal angiography and renal dynamic scintigraphy for suspected ARAS were enrolled in the retrospective descriptive study. Based on the status of renal artery stenosis and renal perfusion, participants were divided into three groups: the control group (n=26), the unilateral ARAS with renal normal perfusion group (RNP, n=30), and the unilateral ARAS with renal slow perfusion group (RSP, n=23). RSP was defined as renal blush grade (RBG) <= 1, while RBG>1 belonged to RNP. Split renal function (SRF) was achieved from 99mTc-DTPA renal scintigraphy. The value of the difference in split renal function (DSRF) is contralateral SRF minus impaired SRF of paired kidneys in ARAS. We compared the SRF and DSRF between different groups to identify the association between renal slow perfusion and renal impairment in ARAS. Results: We analyzed SRF for paired kidneys and found the following: (1) The SRF of the paired kidney was similar in the RNP group (24.3 +/- 10.2 mL/min vs 27.5 +/- 8.4 mL/min; P = 0.19); however, the impaired SRF was obviously decreased compared with the contralateral SRF in the RSP group (13.5 +/- 8.6 mL/min vs 36.7 +/- 16.9 mL/min; P < 0.001); and (2) The difference in SRF in the RSP group was significantly higher than that in the control and RNP groups (19.8 +/- 11.9 mL/min vs 4.8 +/- 8.1 mL/min; 19.8 +/- 11.9 mL/min vs 4.6 +/- 3.7 mL/min; P < 0.05). Conclusion: As an angiographic phenomenon, renal slow perfusion might be an indicator of severely impaired renal function.

A coronary angiography-derived index of microvascular resistance (caIMR) is proposed for physiological assessment of microvasular diseases in coronary circulation. The aim of the study is to assess diagnostic performance of caIMR, using wire-derived index of microvascular resistance (IMR) as the reference standard. IMR was demonstrated in 56 patients (57 vessels) with stable/unstable angina pectoris and no obstructive coronary arteries in three centers using the Certus pressure wire. Based on the aortic pressure wave and coronary angiograms from two projections, the caIMR was computed and assessed in blinded fashion against the IMR at an independent core laboratory. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the caIMR with a cutoff value of 25 were 84.2% (95% CI: 72.1% to 92.5%), 86.1% (95% CI: 70.5% to 95.3%), 81.0% (95% CI: 58.1% to 94.6%), 88.6% (95% CI: 76.1% to 95.0%), and 77.3% (95% CI: 59.5% to 88.7%) against the IMR with a cutoff value of 25. The receiver-operating curve had area under the curve of 0.919 and the correlation coefficient equaled to 0.746 between caIMR and wire-derived IMR. Hence, caIMR could eliminate the need of a pressure wire, reduce technical error, and potentially increase adoption of physiological assessment of microvascular diseases in patients with ischemic heart disease.

目的 评估准分子激光消蚀术在支架内再狭窄病变治疗中的疗效和安全性.方法 回顾性分析从2017年12月至2018年12月在北京医院应用准分子激光消蚀术治疗的支架内再狭窄患者共11例,其中4例(4/11)为慢性完全闭塞病变.11例患者根据参考血管直径、血管狭窄程度选择不同直径的激光导管消蚀病变,后续采用球囊扩张、药物洗脱球囊和(或)药物洗脱支架完成最终治疗.应用定量冠状动脉造影在激光治疗前、激光治疗后及最终影像结果进行最小管腔直径的测量,所有的患者住院期间监测治疗效果,并进行了术后9个月的临床电话随访.结果 11例患者均取得了即刻手术成功,激光治疗后最小管腔直径较治疗前增加[1.37(1.00,2.40)mm比0.76(0.10,2.31)mm,P<0.05].所有患者术中未发生急性血管闭塞、血管夹层.有2例(2/11)患者出现了EllisⅡ型冠状动脉穿孔,未采取任何特殊处理且病情稳定.住院期间无死亡及靶病变血运重建发生.9个月随访时所有患者无死亡、心肌梗死发生,但是仍有2例(2/11)患者进行了靶病变血运重建治疗.结论 准分子激光消蚀术对于复杂的支架内再狭窄病变是一项安全有效的治疗措施.单纯准分子激光消蚀治疗可以明显增加残余管腔直径,可取得满意的术后即刻及9个月治疗效果.

虽然介入治疗可以解除肾动脉狭窄,但粥样硬化性性肾动脉狭窄介入治疗的最佳时机尚不明确.该文从肾动脉狭窄介入治疗现状、专家共识和治疗策略转变三个方面进行综述,认为合并一过性肺水肿、全肾缺血、难治性高血压及肾功能快速减退的高危肾动脉狭窄患者可以从介入治疗中获益.