摘要
目的探讨药物洗脱球囊(DEB)对不稳定型心绞痛患者冠状动脉药物洗脱支架(DES)二次再狭窄(ISR)的临床疗效。方法回顾性选取新乡市中心医院心内科2014年6月至2016年6月冠状动脉造影证实支架内二次ISR、并需再次介入治疗的不稳定型心绞痛患者124例,根据治疗方式分为DEB组和DES组,记录两组患者介入治疗术中、术后即刻冠状动脉情况,并随访术后1年冠状动脉造影情况及主要不良心血管事件发生率。结果两组患者基线临床资料差异无统计学意义(均为P> 0. 05),但两组冠状动脉支架内二次ISR病变多位于前降支、表现为局灶型狭窄;两组患者介入前靶血管直径、靶病变最小直径、靶病变长度及靶血管狭窄百分比差异均无统计学意义(均为P> 0. 05),术后即刻靶血管直径和靶病变最小直径差异亦无统计学意义(均为P> 0. 05),但DES组靶血管即刻获得直径和残余百分比明显优于DEB组(均为P <0. 0001)。随访1年,DES组患者的靶病变最小直径、靶病变直径狭窄百分比、晚期管腔直径丢失和晚期管腔直径净获得均优于DEB组(均为P <0. 05),DES组患者晚期管腔直径丢失率明显小于DEB组(P=0. 003),且急性心肌梗死、全因死亡、靶血管血运重建及靶病变再次血运重建率均低于DEB组(均为P <0. 05)。多因素分析发现,高血压、糖尿病、靶病变长度和支架内弥漫型病变是二次ISR的危险因素,而术后靶血管直径是其保护因素。结论 DEB治疗冠状动脉支架内二次ISR的效果不理想,不应作为冠状动脉支架内二次ISR的首选治疗方案,但需更多研究证实。
Objective To investigate the clinical efficacy of drug-eluting balloon(DEB)in coronary artery drug-eluting stent(DES)re-restenosis in patients with unstable angina pectoris(UAP).Methods A total of 124 UAP patients were enrolled into this study in Cardiology Department of Xinxiang Central Hospital from June of 2014 to June of 2016,who underwent DES-in-stent re-restenosis.According to the treatment,patients were divided into DEB group and DES group.Operative and post-operative data of all patients and major adverse cardiovascular events were recorded by coronary angiography in-hospital and after 1-year followed up. Results There was no significant difference in baseline clinical characteristic of two groups(P>0.05).Most common lesion for in-stent re-restenosis were in left anterior descending artery,presenting as focal lesion.Pre-operative target vessel diameter,the minimum diameter of the target lesion,the length of target lesion and the stenosis percentage of target vessel in two groups did not show significant differences(all P>0.05).Post-operative target vessel diameter and immediate minimum diameter of target lesion were not significantly different(both P>0.05),however immediate diameter of target vessel and residual percentage of target lesion was significantly higher in DES group than in DEB group(both P<0.0001).After 1-year follow-up,minimum diameter of target lesion,stenosis percentage of target lesion,late-loss of lumen diameter and late net gain of lumen diameter was significantly higher in DES group than in DEB group(all P<0.05).Late-loss rate of lumen was significantly smaller in DES group than in DEB group(P=0.003).Acute myocardial infarction,all-cause death,target vessel revascularization and target lesion revascularization rate in DES group were less than that in DEB group(all P<0.05).Multifactor analysis showed that hypertension,diabetes,the length of target lesion and diffuse type of lesion were the risk factors,while post-operative diameter of target vessel was the protective factor for in-stent
作者
韩明磊
金卫东
刘振
王成
崔佳佳
李艳茹
Han Minglei;Jin Weidong;Liu Zhen;Wang Cheng;Cui Jiajia;Li Yanru(Department of Cardiology,Xinxiang Central Hospital,Xinxiang 453000,China)
出处
《中国心血管杂志》
2018年第5期389-393,共5页
Chinese Journal of Cardiovascular Medicine
