Zhang Dai, Sun Yan, Liu Xiaoli, Liu Fang, Cheng Yujing, Ma Xiaoteng, Zhao Yingxin, Zhou Yujie
1 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Chaoyang District, Beijing, China.
Angiology. 2019 May;70(5):414-422. doi: 10.1177/0003319718809423. Epub 2018 Nov 1.
Managing patients with in-stent restenosis (ISR) remains an important clinical challenge. In particular, large, randomized trials assessing the effect of drug-eluting balloons (DEB) in patients with de novo lesions are warranted. We investigated the effect of DEB on procedural complications, target lesion revascularization (TLR), and major adverse cardiac and cerebrovascular events in patients with drug-eluting stent ISR and de novo lesions. The clinical profiles of 238 consecutive patients treated for coronary ISR (n = 174) and de novo lesions (n = 64) using SeQuent Please paclitaxel-coated balloon were analyzed. Study end points were major adverse cardiac events (MACEs). At 1-year follow-up, TLR and MACEs occurred with acceptably low rates (5.0% and 6.3%, respectively). At 2.00 (0.74) years of follow-up, there was a significant difference in the rates of TLR between the ISR and the de novo lesions groups (14.4% [ISR] vs 3.1% [de novo], P = .028), and the occurrence of MACEs distinctly increased in the ISR group compared to the de novo lesions group (21.8% vs 6.2%, P = .009). The long-term outcomes of the ISR group were inferior to those of the de novo group (TLR, log-rank P = .019; MACEs, log-rank P = .010). Drug-eluting balloon for ISR and de novo lesions of small coronary vessels is effective and safe.
处理支架内再狭窄(ISR)患者仍然是一项重要的临床挑战。特别是,开展大型随机试验来评估药物洗脱球囊(DEB)对初发病变患者的疗效很有必要。我们研究了DEB对药物洗脱支架ISR和初发病变患者的手术并发症、靶病变血运重建(TLR)以及主要不良心脑血管事件的影响。分析了连续238例使用SeQuent Please紫杉醇涂层球囊治疗冠状动脉ISR(n = 174)和初发病变(n = 64)患者的临床资料。研究终点为主要不良心脏事件(MACE)。在1年随访时,TLR和MACE的发生率较低(分别为5.0%和6.3%)。在2.00(0.74)年的随访中,ISR组和初发病变组之间的TLR发生率存在显著差异(14.4% [ISR] 对比3.1% [初发病变],P = .028),与初发病变组相比,ISR组MACE的发生率明显增加(21.8%对比6.2%,P = .009)。ISR组的长期预后不如初发病变组(TLR,对数秩检验P = .019;MACE,对数秩检验P = .010)。药物洗脱球囊用于小冠状动脉血管的ISR和初发病变是有效且安全的。