钙化结节对行冠状动脉斑块旋磨术的严重钙化病变患者长期预后的影响

Long-time outcomes of calcifi ed nodule in heavily calcifi ed lesions requiring rotational atherectomy

目的探索钙化结节对行冠状动脉斑块旋磨术的严重钙化病变患者长期预后的影响。方法连续性纳入2015年1月至2020年12月于北京大学人民医院因严重钙化病变行冠状动脉斑块旋磨术并在术中行血管内超声或光学相干断层成像的患者,根据靶病变是否存在钙化结节,分为钙化结节组和非钙化结节组,对比两组患者的长期预后。结果共有81例患者纳入最终分析,其中钙化结节组35例,非钙化结节组46例。两组患者临床资料匹配,钙化结节组患者钙化病变长度[(32.5±13.5)mm比(22.3±9.5)mm,P<0.001]大于非钙化结节组,支架膨胀率[(76.5±6.6)%比(80.0±8.0)%,P=0.036]小于非钙化结节组,差异均有统计学意义。中位随访23(10,40)个月,钙化结节组患者主要不良心血管事件发生率显著高于非钙化结节组(22.9%比6.5%,P=0.034)。结论对于行冠状动脉斑块旋磨术的严重钙化病变患者,存在钙化结节的患者长期预后劣于无钙化结节患者。

Objective To explore the long-time outcomes of calcifi ed nodules in patients with severe coronary calcified lesions requiring rotational atherectomy.Methods Patients who underwent rotational atherectomy due to coronary heavily calcified lesions in our hospital from January 2015 to December 2020 were included consecutively.All the patients received intravascular ultrasound or optical coherence tomography during the procedure.Patients were divided into calcified nodule group and noncalcifi ed nodule group according to whether there were calcifi ed nodules in target lesions.The long-term outcomes of the two groups were compared.Results A total of 81 patients were included in the final analysis,including 35 patients in the calcified nodule group and 46 patients in the non-calcified nodule group.The clinical data of the two groups were matched.The stent expansion rate in the calcifi ed nodule group was lower than that in the non-calcified nodule group[(76.5±6.6)%vs.(80.0±8.0)%,P=0.036].During an average follow-up of 23 months,the incidence of major adverse cardiac events in the calcifi ed nodule group was signifi cantly higher than that in the non-calcifi ed nodule group(22.9%vs.6.5%,P=0.034).Conclusions Calcifi ed nodules are independent predictors of poor long-term outcomes in patients with heavily coronary calcifi ed lesions requiring rotational atherectomy.