直接旋磨和球囊预扩旋磨治疗冠状动脉钙化病变的对比研究

Direct Versus Pre-dilated Rotational Atherectomy for Treating Calcified Coronary Lesions

目的：评价直接旋磨处理冠状动脉钙化病变的效果。方法：回顾性分析2010-04至2014-09我院行冠状动脉旋磨治疗的冠心病患者137例,其缺血相关病变均为钙化病变。根据旋磨前是否进行球囊扩张,分为直接旋磨组81例和预扩旋磨组56例。比较两组术中操作特征,术中即刻并发症,及患者院内和术后1年累积主要不良心脑血管事件（MACCE）发生率。结果：与预扩旋磨组比,直接旋磨组支架前使用球囊数量低（P=0.000）、最大后扩压力高（P=0.004）。直接旋磨组术中并发症显著低于预扩旋磨组（14.8%vs 32.1%,P=0.016）;且术后即刻管腔获得率显著高于预扩旋磨组[（128.52±75.77）%vs（77.12±27.01）%,P=0.004]。与预扩旋磨组相比,直接旋磨组有较低的1年MACCE事件发生率（7.3%vs 23.6%,P=0.006）。Cox回归分析：冠状动脉旋磨处理钙化病变1年MACCE事件的主要相关因素为旋磨前球囊扩张[风险比（HR）=8.166,95%可信区间（CI）：1.872~35.614,P=0.005]、左主干病变（HR=13.649,95%CI：2.983~62.440,P=0.001）、术后最小管腔面积（HR=0.583,95%CI：0.378~0.879,P=0.010）、后扩（HR=0.066,95%CI：0.013~0.332,P=0.001）、射血分数大于40%（HR=0.019,95%CI：0.002~0.158,P=0.000）。结论：直接旋磨有较低的1年MACCE事件发生率。这一获益可能与直接旋磨可以进行有效球囊扩张、减少术中并发症、并获得足够的管腔面积有关。

Objective： To compare the efficacy of direct and pre-dilated atherectomy（RA） for treating the patients with calcified coronary lesions.Methods： A total of 137 coronary artery disease（CAD） patients received RA treatment in our hospital from 2010-04 to 2014-09 were retrospectively studied. The ischemic related lesions were all defined as calcified coronary lesions. The patients were divided into 2 groups： Direct RA group,n=81 and Pre-dilated RA group,the patients received balloon dilatation followed by RA,n=56. The procedural features,complications,in-hospital and 1 year occurrence rates of major cardiaccerebral vascular events（MACCE） were compared between 2 groups.Results： Compared with Pre-dilated RA group,Direct RA group had the less pre-stent balloon application,P=0.000 and the higher maximum post-dilatationpressure,P=0.004; lower rate of in-operative complication（14.8% vs 32.1%）,P=0.016; higher rate of acute lumen gain（128.52±75.77） % vs（77.12±27.01） %,P =0.004; lower MACCE occurrencerate（7.3% vs 23.6%） at 1 year period,P =0.006.Cox regression analysis presented that the following indexes were related to MACCE occurrence within 1 year of RA treatment： balloon dilatation before RA（HR=8.166,95% CI 1.872-35.614,P=0.005）,left main disease（HR=13.649,95% CI 2.983-62.440,P=0.001）,minimum post-operative lumen area（HR=0.583,95% CI 0.378-0.879,P=0.010）,post-dilatation（HR=0.066,95% CI 0.013-0.332,P=0.001） and EF40%（HR=0.019,95% CI 0.002-0.158,P=0.000）.Conclusion： Direct RA had the lower MACCE occurrence rate at 1 year period,this might be related to less operative complication and the optimal lumen gain.