药物涂层球囊经皮冠状动脉介入治疗在多支冠状动脉疾病患者中的临床影响。
Clinical Impact of Drug-Coated Balloon-Based Percutaneous Coronary Intervention in Patients With Multivessel Coronary Artery Disease.
机构信息
Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
出版信息
JACC Cardiovasc Interv. 2023 Feb 13;16(3):292-299. doi: 10.1016/j.jcin.2022.10.049. Epub 2023 Jan 4.
BACKGROUND
Data on drug-coated balloon (DCB) treatment in the context of multivessel coronary artery disease (CAD) are limited.
OBJECTIVES
The purpose of this study was to investigate the impact of DCB-based treatment on percutaneous coronary intervention for multivessel CAD.
METHODS
A total of 254 patients with multivessel disease successfully treated with DCBs or in combination with drug-eluting stents (DES) were retrospectively enrolled (DCB-based group) and compared with 254 propensity-matched patients treated with second-generation DES from the PTRG-DES (Platelet Function and Genotype-Related Long-Term Prognosis in Drug-Eluting Stent-Treated Patients With Coronary Artery Disease) registry (n = 13,160) (DES-only group). Major adverse cardiovascular events (MACE) comprised cardiac death, myocardial infarction, stroke, stent thrombosis, target vessel revascularization, and major bleeding at 2 years.
RESULTS
Baseline clinical characteristics were comparable between the groups. In the DCB-based group, 34.3% of patients were treated with DCBs only and 65.7% were treated with the DES hybrid approach. The number of stents and total stent length were significantly reduced by 65.4% and 63.7%, respectively, in the DCB-based group compared with the DES-only group. Moreover, the DCB-based group had a lower rate of MACE than the DES-only group (3.9% and 11.0%; P = 0.002) at 2-year follow-up. The DES-only group had a higher risk for cardiac death and major bleeding.
CONCLUSIONS
The DCB-based treatment approach showed a significantly reduced stent burden for multivessel percutaneous coronary intervention and led to a lower rate of MACE than the DES-only treatment. This study shows that DCB-based treatment approach safely reduces stent burden in multivessel CAD, and improved long-term outcomes may be expected by reducing stent-related events. (Impact of Drug-Coated Balloon Treatment in De Novo Coronary Lesion; NCT04619277).
背景
多支冠状动脉疾病（CAD）背景下药物涂层球囊（DCB）治疗的数据有限。
目的
本研究旨在探讨 DCB 为基础的治疗对多支 CAD 经皮冠状动脉介入治疗的影响。
方法
回顾性纳入 254 例多支病变患者，这些患者成功接受 DCB 或与药物洗脱支架（DES）联合治疗（DCB 组），并与来自 PTRG-DES（血小板功能和基因型与冠心病患者药物洗脱支架长期预后相关）登记处的 254 例接受第二代 DES 治疗的经匹配倾向评分的患者（DES 组）进行比较（n=13160）。主要不良心血管事件（MACE）包括心脏死亡、心肌梗死、卒中和支架血栓形成、靶血管血运重建和主要出血，随访 2 年。
结果
两组患者的基线临床特征相当。在 DCB 组中，34.3%的患者仅接受 DCB 治疗，65.7%的患者接受 DES 混合治疗方法。与 DES 组相比，DCB 组的支架数量和总支架长度分别显著减少 65.4%和 63.7%。此外，与 DES 组相比，DCB 组在 2 年随访时的 MACE 发生率较低（3.9%和 11.0%；P=0.002）。DES 组心脏死亡和大出血的风险更高。
结论
与单独使用 DES 相比，DCB 为基础的治疗方法在多支经皮冠状动脉介入治疗中显示出明显降低的支架负荷，并导致 MACE 发生率降低。本研究表明，DCB 为基础的治疗方法在多支 CAD 中安全地降低了支架负荷，通过减少支架相关事件，可能会获得更好的长期预后。（药物涂层球囊治疗新发冠状动脉病变的影响；NCT04619277）。
Zotero 插件