老年冠脉分叉病变主支支架植入后在损伤边支使用药物涂层球囊进行修复的临床研究

Clinical effect of repairing the injured side-branch by drug-coated balloon after drug-eluting stent implement at the main-branch in the treatment of elderly patients with coronary bifurcation lesion

目的探讨在对老年冠状动脉分叉病变患者进行介入手术时,采取主支使用药物洗脱支架(DES)后对受损边支使用药物涂层球囊(DCB)进行修复的效果。方法回顾性分析2019年1月至2021年6月期间就诊于首都医科大学附属北京安贞医院心内科接受冠脉介入治疗的260例老年冠心病患者。通过冠脉造影判定属于真分叉病变,采取分叉病变受累主支血管均为支架植入策略,受累边支采用球囊成形策略,根据边支血管最终扩张使用的球囊种类分为普通球囊组或药物球囊组,每组130例。评估术后即刻效果,并在随访期间记录患者主要不良心血管事件(MACE)发生情况。结果普通球囊组与药物球囊组的手术成功率分别为87.7%和89.2%(P>0.05),普通球囊组边支血管最小管腔直径(MLD)从(1.22±0.14)mm增加到(1.53±0.13)mm,药物球囊组边支血管MLD从(1.25±0.12)mm增加到(1.69±0.22)mm。两组患者边支血管术前MLD无明显差异,术后边支血管MLD差异有统计学意义(P<0.05)。两组患者在住院期间,出院后0~3个月、3~6个月、6~12个月随访中均未出现靶血管相关心肌梗死。住院期间普通球囊组和药物球囊组心绞痛分别出现5例(3.8%)和3例(2.3%),均在CCS分级I级(P>0.05)。0~3个月的随访中两组患者行CCS分级后的心绞痛发生率比较差异有统计学意义(P<0.05)。3~6个月及6~12个月两组患者不同CCS分级心绞痛的发生率无明显差异(P>0.05)。3~6个月的随访中普通球囊组出现3例非靶血管心肌梗死(P<0.05);6~12个月随访期间普通球囊组出现6例靶血管血运重建(P<0.05)。两组随访12个月的MACE发生率无明显差异。结论在处理老年冠脉分叉病变时主支支架植入后,对受损边支血管使用DCB进行修复相较于使用普通球囊MLD改善更明显。

Objective To study the repairing effect of drug-coated balloon(DCB)to the injured side-branch after drug-eluting stent(DES)implement at the main-branch in the treatment ofelderly patients with coronary bifurcation lesion.Methods 260 cases of elderly patients with coronary bifurcation lesions was studied in Cardio Department,Beijing Anzhen Hospital,Capital Medical University hospital from January 2019 to June 2021 had implantation of drug-eluting stents in the main branch according to the principle of necessity stenting.Branch application of drug-coated balloons were randomly divided into drug-eluting stents in combination with ordinary coating and drug-eluting stents in combination with drug-coated group,130 cases in each group.Coronary angiography was performed at 12 months,and the incidence of MACE at different periods was recorded.Results The surgical success rates of ordinary balloon group and drug balloon group were 85.8%and 91.2%(P>0.05),respectively,the MLD of lateral branch vessels in the ordinary balloon group increased from(1.22±0.14)mm to(1.53±0.13)mm,and the MLD of branch vessels in the drug balloon group increased from(1.25±0.12)mm to(1.69±0.22)mm.There was no significant difference in preoperative MLD between the two groups,and there was a significant difference in MLD in postoperative branch vessels(P<0.05).During hospitalization,there was no target vascular-related myocardial infarction in 0-3 months,3-6 months,and 6-12 months after discharge.During hospitalization,5 cases(3.8%)and 3(2.3%)of angina pectoris occurred in the general balloon group and the drug balloon group,respectively,all of which were in CCS grade I(P>0.05).In the follow-up of 0-3 months,the incidence of angina pectoris after CCS grading was compared between the two groups(P<0.05).There was no significant difference in the incidence of different CCS-graded angina between the two groups at 3-6 months and 6-12 months(P>0.05).In the 3-6 months follow-up,3 cases of non-target vascular myocardial infarction occurred in the ordinary balloon group(P<0.05);During the 6-12 months follow-up period,6 cases of target vascular revascularization(P<0.05)appeared in the ordinary balloon group.There was no clear difference in the incidence of MACE between the two groups at 12 months follow-up.Conclusion After the implantation of the main branch stent in the treatment of elderly bifurcation lesions,the use of DCB for repair of damaged limb vessels is more obvious than that of ordinary balloon MLD.