冠状动脉旋磨术联合药物涂层球囊治疗冠状动脉严重钙化病变的疗效  

Safety and efficacy of drug-coated balloon following rotational atherectomy for severe coronary artery calcification

作　　者：董昊喆 龚深圳 单迎光[1] 李然[1] 李一鸣 卢旭鹏 孙国举[1] DONG Haozhe;GONG Shenzhen;SHAN Yingguang;LI Ran;LI Yiming;LU Xupeng;SUN Guoju(Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China)

机构地区：[1]郑州大学第一附属医院心血管内科,郑州450052

出　　处：《临床心血管病杂志》2023年第2期108-113,共6页Journal of Clinical Cardiology

摘　　要：目的:探索冠状动脉(冠脉)旋磨术(RA)联合药物涂层球囊(DCB)治疗严重冠脉钙化病变的疗效。方法:连续入选2018年5月—2021年7月就诊于郑州大学第一附属医院因冠脉严重钙化行RA的患者318例,根据不同治疗方案分为RA/DCB组(57例)和RA/药物洗脱支架(DES)组(261例)。比较两组一般临床资料、冠脉病变特征、术中并发症、院内不良事件、随访期间主要心脑血管不良事件(MACCE)发生率。结果:两组基线临床资料、术中并发症、院内不良事件均差异无统计学意义。RA/DES组较多合并左主干病变、分叉病变、弥漫性病变等复杂解剖类型(均P<0.05)。随访期间RA/DES组MACCE(18.77%vs.12.28%)及靶病变血运重建(13.79%vs.7.02%)发生率较RA/DCB组升高,但差异无统计学意义。多因素Cox回归分析显示,分叉病变(HR=2.284,95%CI:1.063~4.908,P=0.034)、植入物总长度(HR=1.023,95%CI:1.005~1.047,P=0.014)、SNYTAX评分(HR:1.047,95%CI:1.013~1.082,P=0.006)是RA-PCI术后远期MACCE发生的危险影响因素。结论:RA联合DCB可对部分适合的钙化病变进行安全有效的治疗。Objective:To assess the safety and efficacy of drug-coated balloons(DCB)following rotational atherectomy(RA)for coronary artery calcification.Methods:A retrospective analysis was performed on 318 consecutive patients with severe coronary artery calcification who underwent RA-assisted PCI at the First Affiliated Hospital of Zhengzhou University from May 2018 to July 2021.Among them,57 patients(RA/DCB group)were treated with drug-coated balloon(DCB),and 261 patients(RA/DES group)were treated with drug-eluting stent(DES).Clinical baseline data,lesions’characteristics,intraoperative complications,in-hospital adverse events,and major adverse cardiovascular and cerebrovascular events(MACCE)throughout the follow-up were compared between the two groups.Results:The baseline clinical data,intra-operative complications,and in-hospital adverse events were not significantly different between the two groups.The anatomical categories included left main coronary disease,bifurcation disease,and multivessel disease in the RA/DES group were more complex and.MACCE(18.77%vs 12.28%)and target lesion revascularization(13.79%vs 7.02%)occurred more frequently in the RA/DES group than those in the RA/DCB group,but there was no statistically significant difference.Multivariate Cox regression analysis showed that bifurcation lesions(HR=2.284,95%CI:1.063-4.908,P=0.034)、total length of DCB/DES(HR=1.023,95%CI:1.005-1.047,P=0.014),and SNYTAX score(HR=1.047,95%CI:1.013-1.082,P=0.006)were independent risk factors of long-term outcomes in patients with severe coronary artery calcification treated with RA.Conclusion:Combined application of RA and DCB can safely and effectively treat some appropriate coronary artery calcification.

关 键 词：钙化病变 药物涂层球囊 冠状动脉旋磨术 药物洗脱支架 

分 类 号：R541.4[医药卫生—心血管疾病]