药物球囊在ST段抬高型心肌梗死急诊冠状动脉诊疗中的有效性和安全性  

The efficacy and safety of drug-coated balloon in patients with ST-segment elevation myocardial infarction

作　　者：上官海娟 郭卉[1] 陈雯雯 张慧 汪敏[1] SHANGGUAN Hai-juan;GUO Hui;CHEN Wen-wen;ZHANG Hui;WANG Min(Department of Cardiovascular,Wuhan Asian heart hospital,Wuhan 430021,China)

机构地区：[1]武汉亚洲心脏病医院心内科,湖北省武汉市430021

出　　处：《中国心血管病研究》2024年第12期1113-1117,共5页Chinese Journal of Cardiovascular Research

基　　金：武汉市卫健委基金项目(WX21D10)。

摘　　要：目的观察药物球囊(DCB)在急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入治疗中的有效性与安全性。探讨冠状动脉CT血流储备分数(CT-FFR)在急诊DCB治疗患者术后随访中的应用价值。方法连续收集2021年6月至2022年6月武汉亚洲心脏病医院接受急诊冠状动脉介入治疗且符合纳入及排除标准的STEMI患者共120例,术中按随机数字分组法分为DCB组(60例)与DES组(60例)。统计两组基本资料及手术资料,记录住院期间及随访9月内主要不良心血管事件(MACE)及出血事件发生情况。对两组患者的基线临床资料、即刻冠状动脉造影结果、术后9个月随访期间MACE及出血事件进行比较,DCB组术后9月行CT-FFR测定。结果DCB组术中冠状动脉夹层发生率高于DES组,差异有统计学意义(16.7%比3.3%,P=0.015),DCB组经充分的预处理后术中冠状动脉夹层多为B型以下;两组TIMI分级、MACE发生率及严重出血事件发生率对比,差异均无统计学意义(P>0.05)。术后9月DCB组32例随访,27例CT-FFR为0.80~0.96,无MACE发生;5例CT-FFR在0.75~0.79,其中1例心绞痛发作,经调整药物后症状缓解。结论与DES相比,STEMI患者经充分的预处理后急诊DCB治疗安全、有效,随访期间CT-FFR≥0.75药物治疗无症状患者可安全推迟冠状动脉造影检查。Objective To observe the efficacy and safety of drug-coated balloon(DCB)in patients with ST-segment elevation myocardial infarction(STEMI)undergoing emergency percutaneous coronary intervention.To explore the predictive value of coronary CT angiography derived fractional flow reserve(CT-FFR)in postoperative follow-up of emergency DCB patients.Methods From June 2021 to June 2022,120 consecutive STEMI patients who received emergency coronary intervention and met the inclusion and exclusion criteria at Wuhan Asian Heart Hospital were collected.Patients were divided into the DCB group(60 patients)and the DES group(60 patients)according to a random number table.Baseline characteristics,operative data,major adverse cardiovascular events(MACE),and bleeding events during hospitalization and 9-month follow-up were collected,The baseline characteristics,radiographic outcomes,MACE and bleeding events during the 9-month follow period were compared between the two groups.CT-FFR was analyzed in DCB Group during the 9-month follow-up period.Results The incidence of coronary dissection in DCB group was significantly higher than that in DES group(16.7%vs.3.3%,P=0.015),after adequate preconditioning,most of the coronary dissections in DCB group were type B or less.The incidence of MACE,TIMI grade and serious bleeding events were similar between the two groups(P>0.05).In DCB Group,32 patients were followed up during the 9-month period,CT-FFR of 27 patients was 0.80-0.96,none of them had MACE;and CT-FFR of 5 patients was 0.75-0.79,one case had an episode of angina pectoris,but the symptoms were relieved after adjusting medication.Conclusion Compared with DES,emergency DCB treatment in STEMI patients after adequate pretreatment is safe and effective,coronary angiography can be safely delayed in asymptomatic patients with CT-FFR≥0.75.

关 键 词：药物涂层球囊 急性心肌梗死 介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]