高频旋磨在冠状动脉钙化病变中的应用:单中心经验  

Rotational atherectomy in calcifi ed coronary lesions : single center experience

作　　者：葛雷[1] 秦晴[1] 陆浩[1] 吴轶喆[1] 钱菊英[1] 樊冰[1] 王齐兵[1] 颜彦[1] 姚康[1] 马剑英[1] 张峰[1] 黄东[1] 沈雳[1] 王翔飞[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心内科,上海200032

出　　处：《中国介入心脏病学杂志》2014年第2期74-78,共5页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金(81300209);上海自然科学基金(12ZR1405200)

摘　　要：目的回顾性分析复旦大学附属中山医院心内科行冠状动脉内高频旋磨术患者临床资料,评估冠状动脉内高频旋磨术的安全性及短期、长期预后。方法连续入选复旦大学附属中山医院自2001年2月至2013年9月行冠状动脉内旋磨术的患者共77例,分析术前及术后冠状动脉造影资料,收集临床信息,并通过门诊及电话随访评估其预后。结果手术成功率为93.5%,住院期间不良临床事件发生率为3.9%,其中心肌梗死1例(1.3%),再次介入治疗及外科旁路移植治疗3例(3.9%);1年随访发现,严重不良心脑血管事件发生率(MACCE)为13.0%,其中急性心肌梗死(MI)发生率为1.3%,靶病变血运重建(TLR)率为9.1%,心源性死亡率为3.9%;在中位时间为1 042 d的长期随访中发现,MACCE发生率为18.2%,其中MI为3.9%,TLR为10.4%,心源性死亡率为5.2%,根据Kaplan-Meier估测长期无MACCE生存率为(53.5±14.4)%。将置入裸金属支架(BMS)患者除外后,置入药物洗脱支架(DES)患者1年MACCE为4.8%,其中TLR为1.6%,长期随访MACCE为12.9%,TLR为4.8%。结论冠状动脉内高频旋磨术后置入支架的手术成功率高,其中置入DES患者的短期及长期预后均较好。Objective This is a retrograde study of patients who underwent rotational atherectomy （RA） in our center to evaluate the safety, short-term and long-term outcomes of this procedure. Methods A total of 77 patients who underwent RA were consecutively enrolled in the study from Feburary2001 to September 2013. Pre and post procedure coronary angiography and clinical information were collected. Long- term outcomes were obtained by outpatient clinical follow-up or telephone interview. Results Procedural success was 93.5% and incidence of in-hospital MACCE was 3.9% with one case （1.3%） of myocardial infarction and 3 cases （3.9%） of reintervention or coronary artery bypass graft therapy. One-year follow- up data indicated that the incidence of MACCE was 13.2%, including myocardial infarction （MI,1.3%）, target lesion revascularization （TLR,9.2%） and cardiac death（3.9%）. During a median follow-up period of 1042 days, the incidence of MACCE was 19.2%. MI occurred in 4.1%, TLR in 11.0% and cardiac death in 5.5%.The cumulative incidence of MACCE-free survival （Kaplan-Meier estimate） was 53.5±14.4%. When analyzing patients with drug eluting stent （DES） implanted, the incidence of one-year MACCE was 4.8% and TLR was 1.6%. During long term follow-up of this subgroup of patients, the incidence of MACCE was 12.9% and TLR was 4.8%. Conclusions RA followed by stent implantation has a high procedural success in treating coronary artery disease. DES implantation has more favorable short- and long- term outcomes.

关 键 词：高频旋磨 冠状动脉钙化病变 单中心经验 

分 类 号：R541.4[医药卫生—心血管疾病]