药物涂层球囊在高出血风险高龄患者冠状动脉原发病变中的应用分析  

Application of Drug-Coated Balloon in The Treatment of De-novo Lesions of Coronary Vessels in Elderly Patients with High Risk of Bleeding

作　　者：赵运海 周磊 朱汉东[1] 鄢华[1] 刘成伟[1] ZHAO Yunhai;ZHOU Lei;ZHU Handong;YAN Hua;LIU Chengwei(Department of Cardiology,Wuhan Asian Heart Hospital,Wuhan 430022,China)

机构地区：[1]武汉亚洲心脏病医院心内科,武汉430022

出　　处：《岭南心血管病杂志》2024年第2期123-128,共6页South China Journal of Cardiovascular Diseases

基　　金：武汉市科技局知识创新专项基础研究项目(项目编号:2022020801010576);湖北省卫生厅科研项目(项目编号:QJX2012-35)。

摘　　要：目的探讨药物涂层球囊(drug-coated balloon,DCB)在高出血风险高龄患者冠状动脉大血管原发病变中应用的安全性和有效性。方法选取武汉亚洲心脏病医院2018年1月至2020年12月行非急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的525例高出血风险(high bleeding risk,HBR)高龄冠状动脉粥样硬化性心脏病(冠心病)患者的临床资料进行回顾性分析,采用病例对照研究,根据PCI治疗方式,DCB治疗组为实验组57例,药物洗脱支架(drug-eluting stent,DES)治疗组为对照组468例,比较两组患者主要不良心血管事件(major adverse cardiovascular events,MACE)[包括靶病变血运重建(target lesion revascularization,TLR)、再发心肌梗死、心源性死亡及出血事件]发生情况。所有患者术后均完成12个月随访。结果DCB组和DES组患者吸烟、合并内科疾病[原发性高血压(高血压)、高脂血症、糖尿病、高尿酸血症]、肌酐值、左心室射血分数(left ventricular ejection fraction,LVEF)比较,差异均无统计学意义(均P>0.05)。两组患者靶病变血管、靶血管参考直径、靶病变血管长度比较,差异均无统计学意义(均P>0.05)。两组患者PCI治疗成功率为100%。12个月随访结果显示,DCB组与DES组患者的MACE发生率比较差异有统计学意义[8.8%vs.24.0%,P<0.05];其中再发心肌梗死率、心源性病死率、靶病变血运重建(target lesion revascularization,TLR)事件发生率比较,差异无统计学意义(均P>0.05);而DCB组患者出血事件发生率明显低于DES组,差异有统计学意义[3.5%vs.14.3%,P<0.05]。结论DCB在高出血风险高龄患者冠状动脉大血管原发病变中应用的疗效并不劣于DES,且降低出血事件发生风险。Objectives To investigate the safety and efficacy of drug-coated balloon(DCB)applied to the de-novo large coronary vessel lesions of elderly patients with high bleeding risk(HBR).Methods The clinical data of 525 elderly patients with coronary heart disease at HBR who underwent non-emergency percutaneous coronary intervention(PCI)in Wuhan Asian Heart Hospital from January 2018 to December 2020 were analyzed retrospectively.The case-control study was used.Depending on the method of PCI,57 cases were divided into experimental(DCB)group and 468 cases were divided into control(drug-eluting stent,DES)group.The incidence of major adverse cardiovascular events(MACE),including target lesion revascularization(TLR),recurrent myocardial infarction,cardiogenic death and bleeding events,was compared between the two groups.All the patients were followed up for 12 months.Results There were no significant differences in smoking,complicated medical diseases(hypertension,hyperlipidemia,diabetes,hyperuricemia),creatinine and left ventricular ejection fraction(LVEF)between DCB group and DES group(all P>0.05).There were no significant differences in the number of basal lesion vessels,target lesion vessels,preoperative stenosis degree of target lesion,and length of target lesion between the two groups(all P>0.05).The success rate of PCI in the two groups was 100%.The results of 12-month follow-up showed that there was a significant difference in the incidence of MACE between DCB group and DES group[8.8%vs.24.0%].There was no significant difference in the rate of recurrent myocardial infarction,cardiac death and target lesion revascularization(TLR)events between the two groups(both P>0.05).The incidence of bleeding events in DCB group was significantly lower than that in DES group(P<0.05).Conclusions DCB are not inferior to DES in the treatment of de-novo large coronary vessel lesions in elderly patients with HBR,and it can reduce the risk of bleeding events.

关 键 词：冠状动脉疾病 药物洗脱支架 球囊扩张 血管成形术 经腔 经皮冠状动脉 

分 类 号：R541.4[医药卫生—心血管疾病]