Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China.
Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China.
BMC Cardiovasc Disord. 2022 Apr 21;22(1):187. doi: 10.1186/s12872-022-02622-9.
Percutaneous coronary intervention (PCI) of heavily calcified lesions (HCLs) is associated with higher complication rates and worse clinical outcomes. Cutting balloon (CB) has been widely used for HCLs, but patients' prognosis had not been fully clarified. The study aimed to compare 3-year clinical outcomes between patients with HCLs that are treated with CBs and those with non-HCLs.
Patients who underwent PCI in Guizhou Provincial People's Hospital from June 2015 to September 2018 were retrospectively included. HCL was defined as radiopaque and high-pressure undilatable lesions. CBs were routinely used in combination with non-compliant balloons for the HCLs. Major adverse cardiac event (MACE) and target vessel failure (TVF) were assessed at 3-year follow-up.
Among 2432 patients included in the study, 210(8.6%) had HCLs with a procedural success rate of 91.0%. The patients with HCLs had a higher incidence of MACE (23.3% vs. 10.8%, P < 0.001) than those with non-HCLs. By propensity score matching, 172 patients with HCLs were 1:1 paired to those with non-HCLs, and their PCI vessels were exactly matched. The MACE and TVF were significantly higher in the patients with HCLs than those with non-HCLs (MACE: 21.5% vs. 13.4%, P = 0.036; TVF: 19.8% vs. 9.9%, P = 0.008). In the Cox regression analysis, HCL is independently associated with higher risks of MACE [HR: 1.72(1.01-2.94), P = 0.047], TVF [HR: 2.10(1.15-3.81), P = 0.015] and repeat revascularization [HR: 2.20(1.07-4.52), P = 0.032].
Patients with HCLs undergoing PCI using CBs in combination with non-compliant balloons had higher risks of complications, procedural failure, and worse clinical outcomes at 3 years than those with non-HCLs.
经皮冠状动脉介入治疗（PCI）重度钙化病变（HCL）与更高的并发症发生率和更差的临床结局相关。切割球囊（CB）已广泛用于 HCL，但患者的预后尚未完全明确。本研究旨在比较 HCL 患者与非 HCL 患者接受 CB 治疗后的 3 年临床结局。
回顾性纳入 2015 年 6 月至 2018 年 9 月在贵州省人民医院接受 PCI 的患者。HCL 定义为不透射线且高压不可扩张的病变。HCL 采用 CB 联合非顺应性球囊治疗。在 3 年随访时评估主要不良心脏事件（MACE）和靶血管失败（TVF）。
本研究共纳入 2432 例患者，其中 210 例（8.6%）存在 HCL，手术成功率为 91.0%。HCL 患者的 MACE 发生率（23.3% vs. 10.8%，P<0.001）高于非 HCL 患者。通过倾向评分匹配，172 例 HCL 患者与 172 例非 HCL 患者 1:1 配对，且 PCI 血管完全匹配。HCL 患者的 MACE 和 TVF 显著高于非 HCL 患者（MACE：21.5% vs. 13.4%，P=0.036；TVF：19.8% vs. 9.9%，P=0.008）。在 Cox 回归分析中，HCL 与 MACE（HR：1.72（1.01-2.94），P=0.047）、TVF（HR：2.10（1.15-3.81），P=0.015）和再次血运重建（HR：2.20（1.07-4.52），P=0.032）的风险升高独立相关。
与非 HCL 患者相比，接受 CB 联合非顺应性球囊治疗的 HCL 患者在 3 年时并发症、手术失败和临床结局更差的风险更高。
