药物涂层球囊在早发冠心病患者中的临床应用分析

Application of drug-coated balloon in patients with premature coronary atherosclerotic heart disease

目的探讨药物涂层球囊(DCB)在早发冠心病(冠状动脉粥样硬化性心脏病)患者中应用的疗效及安全性。方法从2021年1月到2022年3月,在青岛市市立医院连续选择接受冠状动脉造影(CAG)为单支病变的早发冠心病患者(男性≤55岁,女性≤65岁)142例,如冠状动脉狭窄≥90%接受介入干预,狭窄50%~<90%,行冠状动脉血流储备分数(FFR)检查,FFR≤0.8接受介入干预,由术者决定行DCB和/或支架治疗。根据干预方式的不同将患者分为DCB组和药物洗脱支架(DES)组,各71例。9个月随访时复查CAG评估晚期管腔丢失,并进行罪犯病变的FFR功能学评估,评估随访9个月临床事件发生情况,包括心源性死亡、再发心肌梗死、靶血管血运重建。结果DCB组失访或拒绝随访3例,9个月随访时复查CAG 56例,复查FFR 47例。DES组失访或拒绝随访6例,9个月随访时复查CAG 57例,复查FFR 49例。DCB组术后即刻最小管腔直径(MLD)小于DES组[(2.4±0.4)mm比(2.8±0.3)mm](t=2.31,P<0.01),而9个月随访时MLD比较[(2.6±0.6)mm比(2.7±0.4)mm],差异无统计学意义(t=1.20,P=0.37)。DCB组晚期管腔丢失小于DES组[(-0.15±0.09)mm比(0.12±0.10)mm](t=20.83,P<0.01)。9个月随访时DCB组和DES组FFR比较[(0.93±0.04)比(0.92±0.06)],差异无统计学意义(t=1.18,P=0.31)。DCB组与DES组9个月随访临床事件发生率比较差异无统计学意义(P=0.45)。结论DCB在早发冠心病患者中的应用安全有效。

Objective To explore the efficacy and safety of drug-coated balloon(DCB)in patients with premature coronary atherosclerotic heart disease(CHD).Methods Totally 142 patients with premature CHD(male≤55 years old,female≤65 years old)who underwent coronary angiography(CAG)as a single vessel lesion were continuously selected,from January 2021 to March 2022 in Qingdao Municipal Hospital.If the coronary artery stenosis was≥90%,intervention was required.If the stenosis was 50%to<90%,coronary artery fractional flow reserve(FFR)examination was performed.If the FFR was≤0.8,intervention was required,and DCB or stent treatment was decided by the surgeon.The patients were divided into DCB group and drug eluting stent(DES)group based on different intervention methods,with 71 cases each group.At 9-months follow-up,CAG was performed to assess late luminal loss,and FFR functional assessment of culprit lesions was performed to evaluate the occurrence of clinical events at 9 months,including cardiac death,recurrent myocardial infarction,and target vessel revascularization.Results In the DCB group,3 cases were lost or refused follow-up,and 56 cases underwent CAG and 47 cases underwent FFR follow-up at 9 months.In the DES group,6 cases were lost or refused follow-up,and 57 cases underwent CAG and 49 cases underwent FFR follow-up at 9 months.The minimum lumen diameter(MLD)immediately after surgery in the DCB group was smaller than that in the DES group[(2.4±0.4)mm vs(2.8±0.3)mm](t=2.31,P<0.01),while there was no statistically significant difference in MLD at 9 months of follow-up[(2.6±0.6)mm vs(2.7±0.4)mm](t=1.20,P=0.37).The late lumen loss in the DCB group was smaller than that in the DES group[(-0.15±0.09)mm vs(0.12±0.10)mm](t=20.83,P<0.01).At 9-months follow-up,there was no statistically significant difference in FFR between the DCB group and the DES group[(0.93±0.04)vs(0.92±0.06)](t=1.18,P=0.31).There was no statistically significant difference in the 9-months follow-up clinical event incidence between the DCB group and the DES group(P=0.45).Conclusion The use of DCB in patients with premature CHD is safe and effective.