药物涂层球囊在经皮冠状动脉介入治疗中的应用趋势——单中心5年数据分析

The application trend of drug-coated balloon in percutaneous coronary interventions

目的评价药物涂层球囊(DCB)在经皮冠状动脉介入治疗(PCI)中的使用趋势。方法收集2015年3月至2020年2月因冠状动脉粥样硬化性心脏病在解放军总医院第一医学中心行PCI的患者数据,统计近5年来DCB的使用情况,将DCB在支架内再狭窄与原发血管病变中的使用进行比较,并针对原发病变中的应用进一步分析。结果2015年3月至2020年2月共18377例患者接受PCI,其中934例使用DCB,其在PCI患者中的使用占比由1.71%增加至10.31%(P<0.001)。在使用DCB的患者中,支架内再狭窄563例(60.28%);原发病变371例(39.72%),原发血管病变DCB使用由2015年的28例增长为2019年的167例,2015年DCB在原发病变治疗中的使用占比0.98%(28/2849),与2019年4.72%(167/3538)比较,差异有统计学意义(P<0.001),提示DCB在原发病变治疗中各年份间存在线性关系,皮尔森R=–0.09。应用DCB处理原发小血管病变(参考血管直径<2.75 mm)由2015年4.71%(21/446)增至2019年17.49%(124/709),原发大血管病变(参考血管直径≥2.75 mm)的DCB使用0.29%(7/2403)增至1.52%(43/2829)。DCB在原发小血管中应用稳步增长,在原发大血管病变中的使用也逐渐增多,但差异无统计学意义(P=0.720)。左前降支从2015年0.56%(7/1241)增至2019年3.95%(62/1569),差异有统计学意义(P<0.001);左回旋支从1.31%(6/457)增至6.20%(37/597),差异有统计学意义(P<0.001);右冠状动脉从0.22%(2/921)增至2.52%(26/1030),差异有统计学意义(P<0.001);边支血管从5.65%(13/230)增至12.28%(42/342),差异有统计学意义(P=0.006)。DCB在不同部位原发病变中的应用存在线性关系,皮尔森R=–0.17。结论DCB在PCI中的应用逐年增加,不仅作为处理支架内再狭窄病变的重要策略得到越来越多的临床应用,同时在冠状动脉原发病变中的应用也明显增加,并且在原发大血管病变和原发小血管病变中的应用呈同步增加趋势,尤其是在左前降支病变中也得到了越来越多的应用。

Objective To evaluate the use trend of drug-coated balloon(DCB)in percutaneous coronary intervention(PCI).Methods The data of patients with coronary heart disease who underwent PCI in PLA General Hospital from March 2015 to February 2020 were collected.The use of drug balloons in-stent restenosis was compared with that in primary vascular lesions(De novo),and the application of drug balloons in the De novo lesions was further analyzed.Results From March 2015 to February 2020,a total of 18377 patients received PCI,of which 934 patients used DCB,the proportion of which in PCI patients increased from 1.71%to 10.28%(P<0.05).Among the patients using DCB,there were 563 cases of ISR(60.28%),371 cases of De novo lesion(39.72%).The use of DCB for De novo lesion increased from 28 cases in 2015 to 167 cases in 2019.There was a significant diff erence between DCB usage in de novo lesion in 2015 and 2019[0.98%(28/2849)and 4.72%(167/3538)respectively,P<0.001],with a linear relationship with year(Pearson R=–0.09).The rate of DCB usage in primary small vessel lesions(reference vessel diameter<2.75 mm)increased from 4.71%(21/446)to 17.49%(124/709),and in primary vascular lesions(reference vessel diameter≥2.75 mm)increased from 0.29%(7/2403)to 1.52(43/2829),without a statistical significance(P=0.72).The DCB usage in anterior descending artery(LAD)lesions increased from 0.56%(7/1241)in 2015 to 3.95%(62/1569)in 2019,with a significant difference(P<0.001),in LCX increased from 1.31%(6/457)to 6.20%(37/597),with a significant diff erence(P<0.001),in RCA from 0.22%(2/921)to 2.52%(26/1030),with a significant difference(P<0.001),in other branches from 5.65%(13/230)to 12.28%(42/342),with a significant diff erence(P=0.006).The usage of DCB in diff erent location of de novo lesions shown a linear relationship with a Pearson R=–0.17.Conclusions The application of DCB in PCI is increasing year by year,not only as an important strategy for the treatment of instent restenosis,but also in primary coronary artery diseases.And the application in primary lesion and primary small vascular disease showed a synchronous increasing trend,especially in LAD lesions.