应用药物球囊与药物洗脱支架治疗左主干再狭窄分叉病变的对比研究

A comparison between drug-coated balloon angioplasty and drug-eluting stent implantation in patients with left main bifurcation in-stent restenotic lesions

目的对比应用药物球囊(DCB)血管成形术与再次植入药物洗脱支架(DES)治疗左主干再狭窄分叉病变对患者的长期影响。方法回顾性纳入2014年10月—2018年10月在天津市胸科医院因左主干再狭窄分叉病变行介入治疗的患者48例,其中DCB组24例,DES组24例,术前、术后均行冠状动脉造影定量分析,39例(81.3%)患者18个月随访再次行冠状动脉造影及冠状动脉造影定量分析,并对临床终点事件进行长期随访。结果基线资料分析表明,与DES组相比,DCB组非ST段抬高型心肌梗死或ST段抬高型心肌梗死患者比例相似(8.3%比25.0%,P=0.25);具有较高的低密度脂蛋白胆固醇水平[(92.9±35.1)mg/dL比(78.0±30.7)mg/dL,P=0.07],以及更多的双层支架病例(25.0%比4.2%,P=0.05),但均未达统计学意义。PCI后18个月冠状动脉造影定量分析随访,与DES组相比,DCB组晚期管腔丢失差异无显著性[(1.06±1.10)mm比(0.84±1.15)mm,P=0.62],靶病变最小管腔直径差异无显著性[(1.68±0.96)mm比(2.06±1.21)mm,P=0.37]。中位随访时间868天,主要不良心血管事件累计发生率DCB组为25.0%,DES组为29.2%,差异无统计学意义(P=0.75)。结论DCB和DES在左主干再狭窄分叉病变患者中表现出相似的长期临床结局。

Aim To compare the long-term effects of drug-coated balloon angioplasty and drug-eluting stent implantation for left main bifurcation(LMB)-in-stent restenosis(ISR).Methods 48 patients with LMB-ISR,who underwent percutaneous coronary intervention(PCI)between October 2014 and October 2018,were retrospectively reviewed for the present study(repeat drug eluting stent(DES)implantation(n=24),DCB angioplasty(n=24)).Qualitative comparative analysis(QCA)was performed before and after PCI.Thirty-nine patients(81.3%)were followed up for 18 months to perform coronary angiography(CAG)and QCA,and long-term follow-up was conducted for clinical endpoint events.Results Analysis of the baseline characteristics showed that the patients in the DCB group had a similar incidence of non-ST segment elevation myocardial infarction/ST segment elevation myocardial infarction at the index PCI(8.3%vs 25.0%,P=0.25),higher low-density lipoprotein cholesterol level((92.9±35.1)mg/dL vs(78.0±30.7)mg/dL,P=0.07),and more“stent-in-stent”lesions(25.0%vs 4.2%,P=0.05)than those in the DES group but not statistically significant.After 18 months follow up,QCA showed there was no significant difference between the DCB group and the DES group in the late lumen loss((1.06±1.10)mm vs(0.84±1.15)mm,P=0.62),and no significant difference in the minimum lumen diameter of target lesions((1.68±0.96)mm vs(2.06±1.21)mm,P=0.37).The cumulative incidence rates of major adverse cardiovascular events(MACE)were similar between both groups(median follow-up duration was 868 days;MACE rate was 25.0%in the DCB group and 29.2%in the DES group,P=0.75).Conclusion DES and DCB showed comparable long-term clinical results in patients with LMB-ISR lesions.