药物涂层球囊在急性心肌梗死直接经皮冠状动脉介入术中的应用

Drug-coated balloons in primary percutaneous coronary intervention for acute myocardial infarction

目的评估药物涂层球囊(drug-coated balloon,DCB)在急性心肌梗死患者直接经皮冠状动脉介入术(percutaneous coronary intervention,PCI)中的应用效果。方法以2018年8月至2022年7月在首都医科大学附属北京友谊医院接受直接PCI并应用DCB处理罪犯病变的75例急性心肌梗死患者为研究对象,回顾性分析其临床资料、冠状动脉病变特点以及预后情况。结果手术成功率为100%,住院期间临床不良事件发生率为8%。30 d随访中,有2例(2.7%)患者因心力衰竭再入院。在中位时间为16个月的长期随访中,发生非致命性心肌梗死9例(12%)、靶病变血运重建5例(6.7%)、心力衰竭再入院4例(5.3%)、脑卒中3例(4%)。长期累积主要不良心脑血管事件(main adverse cardiovascular and cerebrovascular events,MACCE)发生率为24%,Kaplan-Meier估测长期无MACCE生存率为63.6%(47.3%~79.8%)。结论对于急性心肌梗死中的高选择病变,如原支架内闭塞、小血管病变以及分叉病变,直接PCI时应用DCB血管成形术成功率高,长期预后较好。

Objective This study was to evaluate the efficacy of drug-coated balloons(DCB)for acute myocardial infarction(AMI).Methods A total of 75 AMI patients who underwent primary percutaneous coronary intervention(PCI)with DCB treatment of culprit lesion in Beijing Friendship Hospital,Capital Medical University,from August 2018 to July 2022 were enrolled in this study.The clinical data,characteristics of coronary artery lesion and prognosis were retrospectively analyzed.Results The procedural success rate was 100%,and the incidence of clinical adverse events in hospitalization was 8%.During the 30-day follow-up,2 patients(2.7%)were readmitted for heart failure.During a median follow-up of 16 months,there were 9 cases(12%)of non-fatal myocardial infarction,5 cases(6.7%)of target lesion revascularization,4 cases(5.3%)of heart failure readmission,and 3 cases(4%)of stroke.The long-term cumulative main adverse cardiovascular and cerebrovascular events(MACCE)rate was 24%,and the Kaplan-Meier estimated long-term MACCE-free survival rate was 63.6%(47.3%-79.8%).Conclusions For specific lesions in AMI,such as in-stent occlusion,small vessel disease and bifurcation lesions,DCB angioplasty in primary PCI has a high success rate and a good long-term prognosis.