药物洗脱球囊治疗冠状动脉原位病变的安全性和有效性研究

The safety and efficacy of drug eluting balloon treatment in de novo coronary lesions in coronary heart disease

目的评估药物洗脱球囊(DEB)在冠心病患者冠状动脉原位病变中应用的临床效果。方法回顾性分析2017年5月至2020年5月于北京大学首钢医院心血管内科住院的100例冠心病患者,冠状动脉造影(CAG)检查存在冠状动脉原位病变且行DEB治疗,并在术后4~9个月复查CAG。根据定量冠状动脉造影(QCA)测定狭窄病变的长度、直径以及面积等。主要观察指标为晚期管腔丢失以及晚期净获得,次要观察指标为死亡、靶血管血运重建、非靶血管血运重建、急性心肌梗死、心力衰竭以及出血等。结果入选患者中男74例,女26例,平均年龄(60.1±9.3)岁。共干预病变112处,其中直径≥2.8 mm病变21处(18.8%),急性完全闭塞病变15处(13.4%),分叉病变20处(17.9%)。术前病变长度(13.79±6.26)mm,参考血管直径为(2.36±0.65)mm。术前和术后即刻最小管腔直径分别为(0.80±0.46)mm和(1.59±0.46)mm。无患者在DEB治疗时出现C型及以上夹层。随访期间无患者死亡。2例患者在1个月随访时接受非靶血管血运重建治疗,累计12例患者在6个月随访时接受非靶血管血运重建治疗。随访时最小管腔直径为(1.60±0.46)mm,晚期管腔丢失为(0.016±0.360)mm,晚期净获得为(0.81±0.51)mm。结论冠状动脉原位病变中应用DEB的短期安全性和有效性令人满意。

Objective To evaluate the effect of drug eluting balloon(DEB)treatment in de novo lesions in patients with coronary heart disease.Methods One hundred patients with coronary heart disease admitted to the Department of Cardiology,Shougang Hospital,Peking University from May 2017 to May 2020 were enrolled.All patients had coronary de novo lesion diagnosed by coronary angiography and treated with DEB.The coronary angiography was performed 4 to 9 months after DEB therapy.The length,diameter and area of stenosis lesions were determined by quantitative coronary angiography(QCA).The primary outcome was late lumen loss and net lumen gain,and the secondary outcome were death,target vessel revascularization,non-target vessel revascularization,acute myocardial infarction,heart failure,and bleeding.Results The average age was(60.1±9.3)years,including 74 males and 26 females.A total of 112 lesions were treated.There were 21 lesions(18.8%)with diameter≥2.8 mm,15 lesions(13.4%)with acute total occlusion,and 20 lesions(17.9%)with bifurcation.The mean target lesion length was(13.79±6.26)mm,and the reference vessel diameter was(2.36±0.65)mm.The minimum lumen diameter before and after surgery was(0.80±0.46)mm and(1.59±0.46)mm,respectively.No patients had type C or higher dissection during DEB treatment.No patients died during the follow-up period.Two patients received non-target revascularization at 1 month followup,and a total of 12 patients received non-target revascularization at 6 months follow-up.During the follow-up,the minimum lumen diameter was(1.60±0.46)mm,the late lumen loss was(0.016±0.360)mm,and the net lumen gain was(0.81±0.51)mm.Conclusions The shortterm security and availability of DEB treatment in de novo lesion of coronary artery disease are satisfactory.