药物涂层球囊血管成形术与药物洗脱支架置入术治疗冠状动脉慢性完全闭塞病变疗效对比研究  

Comparison of the efficacy of drug-coated balloon angioplasty and drug-eluting stent implantation in the treatment of chronic total coronary artery occlusion

作　　者：高宇 李子琪 齐斌 母雪飞 经子兰 张权宇 许燕红 荆全民 GAO Yu;LI Zi-qi;QI Bin;MU Xue-fei;JING Zi-lan;ZHANG Quan-yu;XU Yan-hong;JING Quan-min(Graduate Training Base of Northern Theater General Hospital of Jinzhou Medical University,Shenyang 110016,China;不详)

机构地区：[1]锦州医科大学北部战区总医院研究生培养基地,辽宁沈阳110016 [2]北部战区总医院心血管内科,辽宁沈阳110016

出　　处：《中国实用内科杂志》2024年第3期228-234,共7页Chinese Journal of Practical Internal Medicine

基　　金：心脑血管疾病急救新技术应用与路径优化研究(2020JH1/10300002)。

摘　　要：目的 对比药物涂层球囊(DCB)血管成形术与药物洗脱支架(DES)置入术应用于冠状动脉慢性完全闭塞病变(CTO)治疗的临床疗效。方法 选取2020年12月至2021年12月于北部战区总医院心血管内科行冠脉造影显示为CTO病变并成功开通的89例连续入选患者为研究对象,随访期1年,依据2021年DCB亚太专家共识,将治疗方案分为DCB组(n=32)与DES组(n=57);主要观察终点为1年随访患者靶血管血运重建(TVR)情况;次要终点为患者血管造影行定量冠脉造影检查(QCA),靶血管的最小管腔直径(MLD)、平均管腔直径(MVD)、参考管腔直径(RFD)以及晚期管腔直径扩大(LLE)等情况;安全性终点包括手术即时安全性、主要心血管不良事件(MACE)发生率、出血学术研究联合会(BARC)出血分级增加率。结果 本研究平均随访时间为(12±3)个月,两组患者术后1年的TVR发生率分别为12.50%、10.53%,两组差异无统计学意义(P>0.05);安全终点中,两组患者MACE发生率分别为12.50%、12.28%,BRAC出血分级增加率分别为12.50%、14.04%,差异均无统计学意义(P>0.05);在次要终点中,两组MLD、MVD、RFD比较差异均无统计学意义(P>0.05),而两组的LLE分别为0.13(0,0.57)mm、-0.03(-0.22,0)mm,差异有统计学意义(P<0.05)。结论 DCB应用于CTO病变不劣于DES应用于CTO病变,在预扩张充分且无严重夹层血肿的CTO病变中,应用DCB方案的患者远期管腔直径增加明显大于单纯DES方案。Objective To compare the clinical efficacy of drug-coated balloon(DCB)angioplasty with that of drug-eluting stent implantation(DES)for the treatment of chronic total occlusive lesions(CTO)in coronary arteries. Methods A total of 89 patients with CT confirmed by coronary angiography at the Department of Cardiovascular Medicine of the Northern Theater General Hospital between December 2020 and December 2021 and were treated successfully were enrolled continuously as study subjects. The follow-up period was 1 year. The patients were divided into two groups:DCB group(n=32)and DES group(n=57)based on the 2021 DCB Asia-Pacific expert consensus. The main observation endpoint was target vessel revascularization(TVR) at the 1-year follow-up. Secondary endpoints included quantitative coronary angiography(QCA)findings,minimum lumen diameter(MLD),mean vessel diameter(MVD),reference diameter(RFD),and late lumen enlargement(LLE)of target vessels. Safety endpoints included immediate procedural safety,incidence of major adverse cardiovascular events(MACE),and increase rate in bleeding grade according to Bleeding Academic Research Consortium(BARC). Results The average follow-up time was(12±3)months,and the incidence of TVR was 12.50% and 10.53% in the two groups oneyear after surgery, respectively, and there was nosignificant difference between the two groups(P>0.05);the incidence of MACE was 12.50% and 12.28%,respectively,and the increase rates of BRAC bleeding grade were 12.50% and 14.04%,respectively,with no significant difference(P>0.05). There was no significant difference in MLD,MVD or RFD between the two groups(P>0.05),while the LLE of the two groups was 0.13(0,0.57)mm and-0.03(-0.22,0)mm,respectively,and the difference was statistically significant(P<0.05). Conclusion The application of DCB in CTO lesions was not inferior to that of DES in CTO lesions,and the long-term lumen diameter increase of DCB was significantly greater than that of DES alone in CTO lesions with sufficient pre-expansion but without severe dissection

关 键 词：冠状动脉慢性完全闭塞病变 药物涂层球囊血管成形术 经皮冠状动脉介入治疗 药物洗脱支架置入术 

分 类 号：R541.4[医药卫生—心血管疾病]