药物涂层球囊治疗冠状动脉局部急性病变的效果及其对炎症反应的影响

Effects of drug-coated balloons on acute coronary lesions and inflammatory response

目的探究药物涂层球囊(drug-coated balloon,DCB)治疗冠状动脉(冠脉)局部急性病变的效果及其对炎症反应的影响。方法选取入院12 h内行冠脉介入治疗(percutaneous coronary intervention,PCI)的急性心肌梗死患者192例。根据PCI治疗的策略,分为DCB组102例和药物洗脱支架(drug-eluting stent,DES)组90例。观察两组治疗方案在治疗冠脉局部急性病变的效果及其对炎症反应的影响。结果两组患者一般基线资料、病变血管数目、应用DCB/DES尺寸、术前术后心肌梗死溶栓试验(TIMI)血流分级差异无统计学意义(P>0.05)。DCB组术后即刻管腔直径和管腔增益劣于DES组(P<0.01),且DCB组术后血管夹层发生率高于DES组(P<0.01)。9个月复查DCB组晚期管腔丢失(late lumen loss,LLL)优于DES组(P<0.01),两组血流储备分数(fractional flow reserve,FFR)相当。患者院外主要不良心血管事件(major adverse cardiac event,MACE)发生和因双联抗血小板引起出血事件差异无统计学意义(P>0.05)。两组患者相关炎症指标较术前明显降低,且随访时DCB组炎症指标较DES偏低,差异有统计学意义(P<0.01)。结论DCB治疗冠脉局部急性病变的效果不劣于药物洗脱支架,但药物涂层球囊对局部病变的炎症反应有更好的抑制作用,因此DCB可能有更好的远期预后。

Objective To investigate the effectiveness of drug-coated balloons(DCB)in treating acute coronary lesions and their impact on inflammatory response.Methods A total of 192 patients with acute myocardial infarction who underwent percutaneous coronary intervention(PCI)within 12 hours of admission were selected.According to the PCI treatment strategy,they were divided into the DCB group(102 patients)and the drug-eluting stent(DES)group(90 patients).The study observed the effects of the two treatment plans on acute coronary lesions and inflammatory response.Results There were no statistically significant differences between the two groups in general baseline data,lesion vessels,DCB/DES sizes used,or pre-and post-procedure TIMI flow grades(P>0.05).The immediate lumen diameter and lumen gain in the DCB group were inferior to those in the DES group(P<0.O1),and the incidence of vascular dissection in the DCB group was higher than in the DES group(P<0.O1).At the 9-month follow-up,the late lumen loss(LLL)in the DCB group was better than that in the DES group(P<O.O1),and the fractional flow reserve(FFR)was similar between the two groups.There were no statistically significant differences in the incidence of major adverse cardiac events(MACE)and bleeding events caused by dual antiplatelet therapy between the two groups(P>0.05).Inflammatory markers in both groups were significantly lower than pre-procedure levels,and at follow-up,the inflammatory markers in the DCB group were significantly lower than those in the DES group(P<O.O1).Conclusion The efficacy of DCB in treating acute coronary lesions is not inferior to that of DES.Additionally,DCB has a better inhibitory effect on the inflammatory response of local lesions,suggesting potentially better long-term outcomes.