Her Ae Young, Cho Kyoung Im, Singh Gillian Balbir, Garg Scot, Kim Yong Hoon, Koo Bon Kwon, Shin Eun Seok
Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.
Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea.
Yonsei Med J. 2017 Jan;58(1):99-104. doi: 10.3349/ymj.2017.58.1.99.
This study compared the impact of paclitaxel-coated balloons (PCB) or drug eluting stents (DES) on peri-procedural myocardial infarction (PMI) on de novo coronary lesion in stable patients.
In this observational study, we compared the incidence of PMI amongst patients with single vessel de novo coronary lesions who underwent treatment with a PCB or DES. Propensity score-matching analysis was used to assemble a cohort of patients with similar baseline characteristics. PMI was classified as myocardial infarction occurring within 48 hours after percutaneous coronary intervention with a threshold of 5 x the 99th percentile upper reference limit of normal for creatine kinase-myocardial band (CK-MB) or troponin T (TnT).
One hundred four patients (52 receiving PCB and 52 receiving DES) were enrolled in this study. The peak mean values of CK-MB and TnT were significantly higher in the DES group. There was a significantly higher rate of PMI in the DES group (23.1% vs. 1.9%, p=0.002). Total occlusion of the side-branch occurred in two patients treated with DES, while no patients treated with PCB. In multivariable analysis, DES was the only independent predictor of PMI compared with PCB (odds ratio 42.85, 95% confidence interval: 3.44-533.87, p=0.004).
Treatment with a PCB on de novo coronary lesion might be associated with a significant reduction in the risk of PMI compared to DES.
本研究比较了紫杉醇涂层球囊（PCB）或药物洗脱支架（DES）对稳定型患者新发冠状动脉病变围手术期心肌梗死（PMI）的影响。
在这项观察性研究中，我们比较了接受PCB或DES治疗的单支新发冠状动脉病变患者中PMI的发生率。采用倾向评分匹配分析来组建一组具有相似基线特征的患者。PMI被定义为在经皮冠状动脉介入治疗后48小时内发生的心肌梗死，其阈值为肌酸激酶心肌型（CK-MB）或肌钙蛋白T（TnT）正常上限参考值的99百分位数的5倍。
本研究共纳入104例患者（52例接受PCB治疗，52例接受DES治疗）。DES组CK-MB和TnT的峰值均值显著更高。DES组的PMI发生率显著更高（23.1%对1.9%，p=0.002）。接受DES治疗的2例患者出现了侧支血管完全闭塞，而接受PCB治疗的患者中未出现。在多变量分析中，与PCB相比，DES是PMI的唯一独立预测因素（比值比42.85，95%置信区间：3.44-533.87，p=0.004）。
与DES相比，用PCB治疗新发冠状动脉病变可能与PMI风险的显著降低相关。
