冠状动脉重度钙化病变中血管内碎石术与冠状动脉内旋磨术的有效性与安全性比较  

Comparison of the effectiveness and safety of intravascular lithotripsy and intracoronary atherectomy in severely calcified coronary artery lesions

作　　者：许浩杰 徐亚威 李向绕 孟圆 张思源 杨海波[1] XU Haojie;XU Yawei;LI Xiangrao;MENG Yuan;ZHANG Siyuan;YANG Haibo(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》2024年第11期923-928,共6页Journal of Clinical Cardiology

基　　金：国家自然科学基金青年项目(No:81900257);河南省医学科技攻关计划项目(No:LHGJ20220274)。

摘　　要：目的:比较冠状动脉(冠脉)钙化患者接受血管内碎石术或冠脉内旋磨术的安全性和有效性。方法:本研究选取了2023年1月1日—2023年6月30日在郑州大学第一附属医院接受经皮冠脉介入治疗(PCI)的重度冠脉钙化患者中使用血管内碎石术或(和)冠脉内旋磨术的患者,共计142例。根据冠脉钙化斑块处理方式的不同,将患者分为振波组、旋磨组和联合组。收集其基线特征、手术特征、影像数据以及随访结果。主要终点定义为术后180 d内发生主要不良心血管事件(MACE)。主要有效性终点事件定义为手术成功,包括无MACE且残余狭窄<30%主要安全性终点事件定义为术后30 d内未发生MACE。结果:在142例患者中,振波组有28例,旋磨组有102例,联合组有12例。振波组达到主要有效性终点事件的比例为73.3%,旋磨组为50.9%,联合组为76.9%。振波组的主要有效性终点事件比例高于旋磨组(P<0.05),联合组也高于旋磨组(P<0.05)。术后180 d的随访中,3组MACE发生率差异无统计学意义。结论:血管内碎石术在有效性方面优于冠脉内旋磨术,安全性方面相似。Objective:This study was designed to compare the safety and efficacy of intravascular lithotripsy or rotational atherectomy in patients with coronary calcification.Methods:A total of 142 patients with severe coro-nary calcification who underwent percutaneous coronary intervention(PCI)were selected for this study.According to the different treatment methods of calcified plaque,patients were divided into vibration group,rotary grinding group and combined group.Baseline features,surgical features,imaging data and follow-up results were collect-ed.The primary endpoint was defined as major adverse cardiovascular events(MACE)within 180 days after sur-gery.The primary efficacy endpoint event was defined as surgical success,including no MACE and residual steno-sis<30%.The primary safety endpoint event was defined as no MACE within 30 days after surgery.Results:A-mong 142 patients,there were 28 cases in the vibration group,102 cases in the rotary mill group,and 12 cases in the combined group.The proportion of primary effectiveness end point events reached 73.3%in the vibration group,50.9%in the rotary grinding group,and 76.9%in the combined group.The proportion of main effective end point events in the vibration group was higher than that in the rotary grinding group(P<o.05),and the com-bined group was also higher than that in the rotary grinding group(P<o.05).There was no significant difference in the incidence of MACE among the three groups at 180 days post-operative follow-up.Conclusion:Intravascular lithotripsy is superior to coronary rotational atherectomy in terms of effectiveness and similar safety.

关 键 词：冠状动脉粥样硬化性心脏病 冠状动脉钙化病变 血管内碎石术 冠状动脉内旋磨术 

分 类 号：R541.4[医药卫生—心血管疾病]