冠状动脉内旋磨治疗在老年冠心病患者中的安全性和有效性分析

Safety and efficacy of coronary rotational atherectomy in elderly patients with coronary heart disease

目的分析老年冠心病患者行冠状动脉（冠脉）内旋磨治疗的安全性和有效性。方法回顾2012年1月至2016年12月连续在我院接受冠脉内旋磨治疗的107例冠心病患者，分为≥75岁组44例和〈75岁组63例，比较两组旋磨治疗的特征、围术期并发症、即刻手术成功率、1年心血管事件，包括因心绞痛、心肌梗死、心力衰竭而住院，或行再次血运重建及心血管死亡。结果两组旋磨冠脉、参考血管直径、最大旋磨头直径、最大旋磨头与参考血管直径的比值差异无统计学意义（均P〉0.05）。≥75岁组22.7%（10例）的患者使用了2个旋磨头，高于〈75岁组的6.3%（4例）（P ＝0.013），但所用不同尺寸的旋磨头、旋磨次数、最大旋磨转速、最大预扩张压力、最大后扩张压力等两组差异均无统计学意义（均P〉0.05）。≥75岁组和〈75岁组围术期并发症的发生率分别为18.2%（8例）、20.6%（13例）（P ＝0.753），两组各有1例发生旋磨头崁顿，均妥善处置。≥75岁组患者均达到即刻手术成功，〈75岁组的即刻手术成功率为96.8%（61例）（P ＝0.640），两组患者均无住院期间急性或亚急性支架内血栓形成、紧急冠脉旁路移植术等事件发生。两组患者均无1年心血管死亡发生。结论冠脉内旋磨治疗可有效应用于老年冠心病患者，即刻手术成功率高，安全性较好。

ObjectiveTo analyze the safety and efficacy of coronary rotational atherectomy in elderly patients with coronary heart disease.MethodsA total of 107 consecutive patients with coronary artery disease receiving rotational atherectomy from January 2012 to December 2016 were retrospectively analyzed.Patients were divided into an ≥75 years group（n=44）and a 〈75 years group（n=63）. We compared the characteristics of rotational atherectomy, peri-procedural complications, instant procedure success rates and 1-year cardiovascular events, including angina, re-infarction, hospitalization due to heart failure, repeat revascularization and cardiac death.ResultsThere was no significant difference in the target coronary vessel, reference vessel diameter, maximal diameter of the burr and ratio of maximal diameter of the burr to reference vessel diameter between the two groups（all P〉0.05）. Compared with 〈75 years patients, more ≥75 years patients used 2 burrs（10 cases or 22.7% vs.4 cases or 6.3%, P=0.013）, while there was no significant difference in terms of burr size, rotational time, maximal rotational speed, pre- and post-dilation pressure between the two groups（all P〉0.05）. The incidence of peri-procedural complications had no significant difference between the ≥75 years group and the 〈75 years group（8 cases or 18.2% vs.13 cases or 20.6%, P=0.753）. One case of burr entrapment occurred in each group with successful retrieval.The procedure success rate was 96.8%（61 cases）in the 〈75 years group and 100% in the ≥75 years group（P=0.640）. No acute or sub-acute stent thrombosis or urgent coronary artery bypass graft occurred in the two groups during hospitalization.No cardiac death occurred in either group.ConclusionsCoronary rotational atherectomy is effective and safe in elderly patients with coronary disease with a high instant procedure success rate.