冠状动脉斑块旋磨术治疗冠状动脉弥漫钙化病变的长期安全性及有效性

Long-time outcomes of rotational atherectomy of diffuse calcified coronary artery lesions

目的评估冠状动脉斑块旋磨术治疗冠状动脉弥漫钙化病变的长期安全性及有效性。方法连续纳入2015年1月至2020年12月于北京大学人民医院因重度钙化病变行冠状动脉斑块旋磨术并符合研究入选标准的188例患者。根据旋磨靶病变长度分为弥漫病变(≥25 mm)旋磨组(98例)和标签内旋磨组(90例),比较两组患者旋磨术中并发症(C型以上冠状动脉夹层、慢血流/无复流、冠状动脉破裂、旋磨导丝断裂、旋磨头嵌顿)、住院期间主要不良心血管事件(全因死亡、经皮冠状动脉介入治疗相关心肌梗死、靶血管再次血运重建、急性/亚急性支架内血栓形成)及随访期间主要不良心血管事件(全因死亡、非致死性心肌梗死、靶血管再次血运重建、支架内血栓形成)的发生率。结果两组患者临床基线资料匹配,差异无统计学意义(均P>0.05)。弥漫病变旋磨组旋磨术中并发症发生率高于标签内旋磨组(7.1%比3.3%,P=0.247),尤其是慢血流/无复流的发生率(5.1%比1.1%,P=0.121),但差异均无统计学意义。两组患者住院期间主要不良心血管事件发生率的差异无统计学意义(7.8%比11.2%,P=0.923),平均随访33.4个月,两组患者主要不良心血管事件发生率的差异无统计学意义(14.4%比15.3%,P=0.489)。结论与标签内旋磨相比,冠状动脉斑块旋磨术治疗弥漫钙化病变安全有效,不增加住院期间和远期心血管事件风险。

Objective To evaluate the long-term outcomes of rotational atherectomy(RA)of diffuse calcified coronary artery lesions.Methods A total of 188 patients who underwent RA in Peking University People’s Hospital from January 2015 to December 2020 were included in the study.According to the length of the target lesion,the patients were divided into diffuse lesion group(≥25 mm,98 cases)and on-label group(90 cases).The incidence of complications during RA[coronary dissection(at least type C),slow/no-reflow,coronary perforation,Rota-wire fracture and Burr entrapment]and the major adverse cardiovascular event in hospitalization(the composite end of all-cause death,PCI related myocardial infarction,target vessel revascularization and stent thrombosis)and follow-up(the composite end of all-cause death,nonfatal myocardial infarction,target vessel revascularization and stent thrombosis)were compared between groups.Results The baseline data of the two groups were comparable.The incidence of complications during RA in diffuse lesion group was higher than that in on-label group(7.1%vs.3.3%,P=0.247),especially the incidence of slow/no reflow(5.1%vs.1.1%,P=0.121),but the difference was not statistically significant.There was no difference between the two groups in the major cardiovascular event(7.8%vs.11.2%,P=0.923)during hospitalization.During 33.4 months follow-up,there was no difference in the major cardiovascular event between the two groups(14.4%vs.15.3%,P=0.489).Conclusions Compared with on-label RA,treating diffuse calcified lesions with RA does not impact short-and long-term outcomes.