单纯药物涂层球囊在假性冠状动脉左主干分叉病变中的疗效及安全性

The efficacy and safety of simple drug-coated balloon in the treatment of pseudo-left main bifurcation lesions of coronary arteries

摘要:

目的]通过与即兴支架术(PS)对比,探讨单纯药物涂层球囊(DCB)治疗假性冠状动脉左主干(LM)分叉病变的安全性及有效性。 [方法]回顾性分析2018年1月—2023年1月在郑州大学第二附属医院行冠状动脉造影明确为假性LM分叉病变并行介入治疗的175例患者,按照手术策略分为药物洗脱支架(DES)组99例与DCB组76例,记录术前、术后即刻冠状动脉造影定量(QCA)分析数据,并对其进行随访,随访终点为主要不良心血管事件(MACE)发生,以及入院复查冠状动脉造影,记录随访时QCA数据。 [结果]DCB组术后即刻最小管腔直径、术后即刻管腔获得在LM、左前降支(LAD)、左回旋支(LCX)均小于DES组(P＜0.05),术后即刻残余狭窄程度均大于DES组(P＜0.05)。对随访患者复查冠状动脉造影结果行QCA,DCB组随访时最小管腔直径在LM、LAD、LCX均小于DES组(P＜0.05),随访时管腔残余狭窄程度均大于DES组(P＜0.05),但在晚期管腔丢失方面,DCB组在LM、LAD、LCX均小于DES组,差异有统计学意义(P＜0.05)。两组患者在随访期间的术后不良心血管事件发生率差异无统计学意义(P＞0.05)。Cox回归分析结果显示介入治疗方案(DCB治疗或PS术)的选择对MACE发生风险的影响无统计学意义(P＞0.05)。 [结论]与PS术相比,单纯DCB治疗假性LM分叉病变具有相对满意的疗效及安全性,可以作为假性LM分叉病变介入治疗的一种可供选择的手术策略。

Abstract:

Aim To explore the safety and efficacy of simple drug-coated balloon (DCB) compared with provisional stenting (PS) in the treatment of pseudo-left main (pseudo-LM) bifurcation lesions. Methods A retrospective analysis was performed on 175 patients who underwent coronary angiography for pseudo-LM bifurcation lesions and interventional treatment at the Second Affiliated Hospital of Zhengzhou University from January 2018 to January 2023. According to the treatment strategy, they were divided into drug-eluting stent (DES) group (99 cases) and DCB group (76 cases).Preoperative and immediate postoperative quantitative coronary angiography (QCA) data were recorded, and patients were followed up. The follow-up endpoints included the occurrence of major adverse cardiovascular events (MACE) and hospital re-admission. Coronary angiography and QCA data during follow-up were also recorded. Results The immediate postoperative minimum lumen diameter and lumen gain in the left main (LM), left anterior descending (LAD), and left circumflex (LCX) arteries of the DCB group were smaller than those of the DES group (P＜0.05), while the degree of residual lumen stenosis immediately after surgery was greater than that of the DES group (P＜0.05). QCA was performed on the coronary angiography results of follow-up patients. The minimum lumen diameter in LM, LAD, and LCX was smaller in the DCB group than in the DES group during follow-up (P＜0.05). The degree of residual lumen stenosis during follow-up was greater in the DCB group than in the DES group (P＜0.05), but the late lumen loss in LM, LAD, and LCX was smaller in the DCB group than that in the DES group, with statistically significant differences (P＜0.05). There was no significant difference in the incidence of postoperative MACE between the two groups during the follow-up period (P＞0.05). Cox regression analysis showed that the choice of interventional treatment (DCB vs. PS) had no significant impact on the risk of MACE (P＞0.05). Conclusion Compared with PS, DCB alone demonstrates relatively satisfactory efficacy and safety in the treatment of pseudo-LM bifurcation lesions and can be considered as an alternative treatment strategy for interventional therapy of such lesions.