候静波

• 1:哈尔滨医科大学附属第二医院心内科

摘要(Abstract)：

冠心病介入正由造影狭窄导向转向以病变机制识别和影像优化为核心的精准介入。血管内超声(IVUS)和光学相干断层成像(OCT)可提供血管壁及斑块信息。在急性冠状动脉综合征(ACS)中，OCT对斑块破裂、侵蚀和钙化结节的识别，为机制分型及严格筛选患者的无支架治疗提供依据。腔内影像还可指导复杂经皮冠状动脉介入治疗(PCI)、药物涂层球囊(DCB)应用和非罪犯高危斑块识别，但获益取决于影像能否改变策略并达到标准化优化目标。随着标准化数据库和人工智能(AI)辅助分析的发展，腔内影像有望成为贯穿冠心病诊疗与随访的精准平台。

关键词(KeyWords)： 冠心病;腔内影像;光学相干断层成像;血管内超声;精准介入

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 候静波

DOI: 10.13201/j.issn.1001-1439.2026.10.002

参考文献(References)：

• [1] Global Burden of Cardiovascular Diseases and Risks 2023 Collaborators.Global,regional,and national burden of cardiovascular diseases and risk factors in 204 countries and territories,1990-2023[J].J Am Coll Cardiol,2025,86(22):2167-2243.
• [2] 国家心血管病中心，中国心血管健康与疾病报告编写组.中国心血管健康与疾病报告2025概要[J].中国循环杂志，2026,41(6):527-563.
• [3] Vrints C,Andreotti F,Koskinas KC,et al.2024 ESC guidelines for the management of chronic coronary syndromes[J].Eur Heart J,2024,45(36):3415-3537.
• [4] Rao SV,O'Donoghue ML,Ruel M,et al.2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes:a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J].Circulation,2025,151(13):e771-e862.
• [5] Tearney GJ,Regar E,Akasaka T,et al.Consensus standards for acquisition,measurement,and reporting of intravascular optical coherence tomography studies:a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation[J].J Am Coll Cardiol,2012,59(12):1058-1072.
• [6] Jia H,Abtahian F,Aguirre AD,et al.In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography[J].J Am Coll Cardiol,2013,62(19):1748-1758.
• [7] R??ber L,Mintz GS,Koskinas KC,et al.Clinical use of intracoronary imaging.Part 1:guidance and optimization of coronary interventions:an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions[J].Eur Heart J,2018,39(35):3281-3300.
• [8] Jia H,Dai J,Hou J,et al.Effective anti-thrombotic therapy without stenting:intravascular optical coherence tomography-based management in plaque erosion[J].Eur Heart J,2017,38(11):792-800.
• [9] He L,Qin Y,Xu Y,et al.Predictors of non-stenting strategy for acute coronary syndrome caused by plaque erosion:four-year outcomes of the EROSION study[J].EuroIntervention,2021,17(6):497-505.
• [10] Jia H,Dai J,He L,et al.EROSION III:a multicenter RCT of OCT-guided reperfusion in STEMI with early infarct artery patency[J].JACC Cardiovasc Interv,2022,15(8):846-856.
• [11] He L,Hu S,Zhao C,et al.Five-year follow-up of OCT-guided percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction[J].EuroIntervention,2024,20(15):e937-e947.
• [12] Lee JM,Choi KH,Song YB,et al.Intravascular imaging-guided or angiography-guided complex PCI[J].N Engl J Med,2023,388(18):1668-1679.
• [13] Holm NR,Andreasen LN,Neghabat O,et al.OCT or angiography guidance for PCI in complex bifurcation lesions[J].N Engl J Med,2023,389(16):1477-1487.
• [14] Hong SJ,Lee SJ,Lee SH,et al.Optical coherence tomography-guided versus angiography-guided percutaneous coronary intervention for patients with complex lesions(OCCUPI):an investigator-initiated,multicentre,randomised,open-label,superiority trial in South Korea[J].Lancet,2024,404(10457):1029-1039.
• [15] Kang DY,Ahn JM,Yun SC,et al.Optical coherence tomography-guided or intravascular ultrasound-guided percutaneous coronary intervention:the OCTIVUS randomized clinical trial[J].Circulation,2023,148(16):1195-1206.
• [16] Ali ZA,Landmesser U,Maehara A,et al.Optical coherence tomography-guided versus angiography-guided PCI[J].N Engl J Med,2023,389(16):1466-1476.
• [17] Kim H,Kang DY,Ahn JM,et al.Proportion and clinical impact of stent optimization during imaging-guided percutaneous coronary intervention:the OCTIVUS trial[J].JACC Cardiovasc Interv,2025,18(9):1089-1099.
• [18] Gao X,Kan J,Chen Y,et al.IVUS or angiography guidance for percutaneous coronary intervention in complex coronary bifurcation lesions:the DKCRUSH VIII randomized clinical trial[J].J Am Coll Cardiol,2026,87(16):2080-2095.
• [19] Diletti R,Daemen J,Faurie B,et al.Intravascular ultrasound-guided or angiography-guided complex high-risk PCI[J].N Engl J Med,2026,394(22):2200-2211.
• [20] Testa L,De la Torre Hernandez JM,De Maria GL,et al.IVUS-guided versus angiography-guided PCI in unprotected left main coronary disease[J].N Engl J Med,2026,394(22):2189-2199.
• [21] Sato T,Matsumura M,Yamamoto K,et al.A revised optical coherence tomography-derived calcium score to predict stent underexpansion in severely calcified lesions[J].JACC Cardiovasc Interv,2025,18(5):622-633.
• [22] Riley RF,Patel MP,Abbott JD,et al.SCAI expert consensus statement on the management of calcified coronary lesions[J].J Soc Cardiovasc Angiogr Interv,2024,3(2):101259.
• [23] Giacoppo D,Alfonso F,Xu B,et al.Paclitaxel-coated balloon angioplasty vs drug-eluting stenting for the treatment of coronary in-stent restenosis:a comprehensive,collaborative,individual patient data meta-analysis of 10 randomized clinical trials(DAEDALUS study)[J].Eur Heart J,2020,41(38):3715-3728.
• [24] Yeh RW,Shlofmitz R,Moses J,et al.Paclitaxel-coated balloon vs uncoated balloon for coronary in-stent restenosis:the AGENT IDE randomized clinical trial[J].JAMA,2024,331(12):1015-1024.
• [25] Xhepa E,Bresha J,Joner M,et al.Clinical outcomes by optical characteristics of neointima and treatment modality in patients with coronary in-stent restenosis[J].EuroIntervention,2021,17(5):e388-e395.
• [26] Gao XF,Ge Z,Kong XQ,et al.Intravascular ultrasound vs angiography-guided drug-coated balloon angioplasty:the ULTIMATE III trial[J].JACC Cardiovasc Interv,2024,17(13):1519-1528.
• [27] Fezzi S,Giacoppo D,Fahrni G,et al.Individual patient data meta-analysis of paclitaxel-coated balloons vs drug-eluting stents for small-vessel coronary artery disease:the ANDROMEDA study[J].Eur Heart J,2025,46(17):1586-1599.
• [28] Tao L,He X,Shen G,et al.Drug-coated balloon angioplasty vs up-front stenting for de novo CAD:3-year follow-up of REC-CAGEFREE I[J].J Am Coll Cardiol,2026,87(3):312-329.
• [29] Fezzi S,Serruys PW,Cortese B,et al.Indications for use of drug-coated balloons in coronary intervention:Academic Research Consortium position statement[J].J Am Coll Cardiol,2025,86(15):1170-1202.
• [30] Erlinge D,Maehara A,Ben-Yehuda O,et al.Identification of vulnerable plaques and patients by intracoronary near-infrared spectroscopy and ultrasound:the PROSPECT II study[J].Lancet,2021,397(10278):985-995.
• [31] Prati F,Romagnoli E,Gatto L,et al.Relationship between coronary plaque morphology of the left anterior descending artery and 12 months clinical outcome:the CLIMA study[J].Eur Heart J,2020,41(3):383-391.
• [32] Kedhi E,Berta B,Roleder T,et al.Thin-cap fibroatheroma predicts clinical events in diabetic patients with normal fractional flow reserve:the COMBINE OCT-FFR trial[J].Eur Heart J,2021,42(45):4671-4679.
• [33] Park SJ,Ahn JM,Kang DY,et al.Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable atherosclerotic coronary plaques(PREVENT):a multicentre,open-label,randomised controlled trial[J].Lancet,2024,403(10438):1753-1765.
• [34]R??ber L,Ueki Y,Otsuka T,et al.Effect of alirocumab added to high-intensity statin therapy on coronary atherosclerosis in patients with acute myocardial infarction:the PACMAN-AMI randomized clinical trial[J].JAMA,2022,327(18):1771-1781.
• [35]Chu M,Jia H,Gutiérrez-Chico JL,et al.Artificial intelligence and optical coherence tomography for the automatic characterisation of human atherosclerotic plaques[J].EuroIntervention,2021,17(1):41-50.
• [36]V olleberg RHJA,Luttikholt TJ,van der Waerden RGA,et al.Artificial intelligence-based identification of thin-cap fibroatheromas and clinical outcomes:the PECTUS-AI study[J].Eur Heart J,2025,46(46):5032-5041.
• [37]van der Waerden RGA,Volleberg RHJA,Luttikholt TJ,et al.Artificial intelligence for the analysis of intracoronary optical coherence tomography images:a systematic review[J].Eur Heart J Digit Health,2025,6(2):270-284.