急诊经皮冠状动脉介入治疗应用药物涂层球囊处理极晚期支架内血栓形成:一项单中心回顾性研究

Emergency percutaneous coronary intervention with drug-coated balloons for very late stent thrombosis:a single-center retrospective study

目的评估急诊经皮冠状动脉介入治疗(PCI)手术的极晚期支架内血栓形成(VLST)患者,术中应用药物涂层球囊(DCB)的安全性及有效性。方法首都医科大学附属北京友谊医院自2018年8月1日至2022年7月31日完成急诊PCI手术746例,其中VLST患者共38例,收集临床信息,分析其冠状动脉造影资料,并通过门诊及电话随访评估其预后。结果所有患者均采用DCB处理罪犯病变,其中7例联合置入药物洗脱支架(DES),手术成功率为100%,住院期间无严重主要不良心脑血管事件(MACCE)发生。30 d随访中,有2例(5.3%)因心力衰竭再入院。1年随访中MACCE发生率为7例(18.4%),其中非致死性脑卒中1例(2.6%),心力衰竭再入院3例(7.9%),非致死性心肌梗死3例(7.9%),包括靶病变再次血运重建(TLR)1例(2.6%)。在中位时间为16个月的长期随访中,MACCE发生率为36.8%,其中非致死性心肌梗死为7例(18.4%),TLR为5例(13.2%),心力衰竭再入院3例(7.9%),非致死性脑卒中2例(5.3%)。Kaplan-Meier估测长期无MACCE生存率为(56.1±9.6)%。结论急诊PCI术中应用DCB处理VLST手术成功率高,短期预后较好;长期随访发现可获得相对较低的TLR发生率。

Objective The aim of this single center retrospective study was to assess the effi cacy and safety of emergency percutaneous coronary intervention(PCI)using drug-coated balloon(DCB)in very late stent thrombosis(VLST)lesions.Methods Among a total of 746 patients underwent emergency PCI from August 2018 to July 2022 in our center,38 VLST patients were enrolled in this study.Coronary angiograms and clinical information of these patients were collected.All medical and follow-up data were obtained from our institutional database.Results All patients were treated with DCB,and 7 of them were implanted with drug-eluting stents(DES)simultaneously.The success rate of the procedure was 100%,and no major adverse cardiovascular and cerebrovascular events(MACCE)occurred during hospitalization.During the 30-day follow-up,only 2 patients(5.3%)were readmitted for heart failure.MACCE at 1-year follow-up was 18.4%,including 2.6%for non-fatal stroke,7.9%for heart failure readmission,7.9%for non-fatal myocardial infarction,and 2.6%for target lesion revascularization(TLR).Over a median follow-up of 16 months,the incidence of MACCE was 36.8%,including 18.4%for nonfatal myocardial infarction and 13.2%for TLR et al.The long-term MACCE-free survival was(56.1±9.6)%.Conclusions The application of DCB to the treatment of VLST lesions in emergency PCI has a high success,a good short-term prognosis,and a low incidence of TLR during long-term follow-up.