非ST段抬高型急性冠状动脉综合征患者使用药物洗脱球囊的情况。

Drug-eluting balloons in patients with non-ST elevation acute coronary syndrome.

作者信息

Besic Kristina Maric, Strozzi Maja, Margetic Eduard, Bulum Josko, Kolaric Branko

机构信息

Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.

出版信息

J Cardiol. 2015 Mar;65(3):203-7. doi: 10.1016/j.jjcc.2014.05.007. Epub 2014 Jun 26.

DOI:10.1016/j.jjcc.2014.05.007

PMID:24976525

Abstract

BACKGROUND

We compared efficacy of bare-metal stent (BMS) and drug-eluting balloon (DEB) combination vs BMS alone, in patients with non-ST elevation acute coronary syndrome treated with percutaneous coronary intervention (PCI).

METHODS

Patients with non-ST elevation myocardial infarction (NSTEMI) or unstable angina (UA) were randomized to BMS only or BMS+DEB group. Angiographic follow-up was performed after 6 months. The primary endpoints were binary in-stent restenosis (ISR) and late lumen loss (LLL) and the secondary endpoints were target lesion revascularization (TLR), stent thrombosis (ST), and new acute coronary syndrome (ACS).

RESULTS

A total of 85 patients were enrolled, 44 (BMS) and 41 (BMS+DEB). The median age was 67 (36-84) years and 68 (80%) were male. Fifty-two patients (61.2%) had NSTEMI and 33 patients (38.8%) UA. There was no difference in patient demographics, risk factors, and clinical characteristics, except for more smokers in the BMS+DEB group 18/41 (43.9%) vs 9/44 (20.5%). At follow-up, no significant difference in binary ISR was found; p=0.593, but LLL was significantly lower in the BMS+DEB group 0.68 (0.00-2.15) mm vs 0.22 (0.00-2.35) mm; p=0.002. The difference in major adverse cardiac events (MACE) rate combining TLR, ST, and ACS, between the groups was also non-significant, 29.5% (BMS) vs 24.4% (BMS+DEB); p=0.835. One patient had a subacute ST (BMS+DEB) due to clopidogrel resistance.

CONCLUSION

Patients treated with BMS+DEB combination for non-ST elevation acute coronary syndrome had significantly less LLL in comparison to patients treated with BMS alone but without an impact on patient clinical outcomes.

摘要

背景

我们比较了裸金属支架（BMS）与药物洗脱球囊（DEB）联合使用与单独使用BMS，在接受经皮冠状动脉介入治疗（PCI）的非ST段抬高型急性冠状动脉综合征患者中的疗效。

方法

将非ST段抬高型心肌梗死（NSTEMI）或不稳定型心绞痛（UA）患者随机分为单纯BMS组或BMS+DEB组。6个月后进行血管造影随访。主要终点为二元支架内再狭窄（ISR）和晚期管腔丢失（LLL），次要终点为靶病变血运重建（TLR）、支架血栓形成（ST）和新发急性冠状动脉综合征（ACS）。

结果

共纳入85例患者，44例（BMS组）和41例（BMS+DEB组）。中位年龄为67岁（36-84岁），68例（80%）为男性。52例患者（61.2%）患有NSTEMI，33例患者（38.8%）患有UA。患者的人口统计学、危险因素和临床特征无差异，但BMS+DEB组吸烟者更多，为18/41（43.9%），而BMS组为9/44（20.5%）。随访时，二元ISR无显著差异；p=0.593，但BMS+DEB组的LLL显著更低，为0.68（0.00-2.15）mm，而BMS组为0.22（0.00-2.35）mm；p=0.002。两组之间联合TLR、ST和ACS的主要不良心脏事件（MACE）发生率差异也不显著，分别为29.5%（BMS组）和24.4%（BMS+DEB组）；p=0.835。1例患者（BMS+DEB组）因氯吡格雷抵抗发生亚急性ST。