Gunawardena Tharusha D, Corballis Natasha, Merinopoulos Ioannis, Wickramarachchi Upul, Reinhold Johannes, Maart Clint, Sreekumar Sulfi, Sawh Chris, Wistow Trevor, Sarev Toomas, Ryding Alisdair, Gilbert Tim J, Clark Allan, Vassiliou Vassilios S, Eccleshall Simon
Department of Cardiology, Norfolk and Norwich University Hospital, Norwich NR4 7UY, UK.
Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
J Cardiovasc Dev Dis. 2023 Feb 16;10(2):84. doi: 10.3390/jcdd10020084.
The objective of this study is to compare the outcomes of patients treated with drug-coated balloons (DCBs) or second-generation drug-eluting stents (DESs) for de novo unprotected left main stem (LMS) disease. Previous studies comparing the treatment of LMS disease suggest that the mortality for DES PCI is not worse than CABG. There are limited data from studies investigating the treatment of de novo LMS disease with DCB angioplasty. We compared the all-cause and cardiac mortality of patients treated with paclitaxel DCB to those with second-generation DES for de novo LMS disease from July 2014 to November 2019. Data were analysed using Kaplan-Meier analyses and propensity-matched analyses. A total of 148 patients were treated with either a DCB or DES strategy. There was no significant difference in all-cause mortality in the DCB group (19.5%) compared to the DES group (15.9%) (HR 1.42 [0.61-3.32], = 0.42). Regarding cardiac mortality, 2 (4.9%) were recorded for the DCB group and 7 (6.5%) for the DES group (HR 1.21 [0.31-4.67], 0.786); for target vessel myocardial infarction, there were 0 (0%) for the DCB group and 7 (6.5%) for the DES group; and for target lesion revascularisation, there were 3 (7.3%) in the DCB group and 9 (8.3%) in the DES group (HR: 0.89 [0.24-3.30]). = 0.86. These remained not significant after propensity score matching. We found no difference in the mortality outcomes with DCB angioplasty compared to second-generation DES, with a median follow-up of 33 months. DCB can therefore be regarded as a safe option in the treatment of LMS disease in suitable patients.
本研究的目的是比较药物涂层球囊（DCB）或第二代药物洗脱支架（DES）治疗初发无保护左主干（LMS）疾病患者的疗效。既往比较LMS疾病治疗方法的研究表明，DES经皮冠状动脉介入治疗（PCI）的死亡率并不比冠状动脉旁路移植术（CABG）差。关于DCB血管成形术治疗初发LMS疾病的研究数据有限。我们比较了2014年7月至2019年11月期间接受紫杉醇DCB治疗与接受第二代DES治疗的初发LMS疾病患者的全因死亡率和心脏死亡率。采用Kaplan-Meier分析和倾向匹配分析对数据进行分析。共有148例患者接受了DCB或DES治疗策略。DCB组的全因死亡率为19.5%，DES组为15.9%，两组之间无显著差异（风险比[HR]为1.42[0.61-3.32]，P=0.42）。关于心脏死亡率，DCB组记录到2例（4.9%），DES组记录到7例（6.5%）（HR为1.21[0.31-4.67]，P=0.786）；关于靶血管心肌梗死，DCB组为0例（0%），DES组为7例（6.5%）；关于靶病变血运重建，DCB组有3例（7.3%），DES组有9例（8.3%）（HR：0.89[0.24-3.30]，P=0.86）。倾向评分匹配后这些结果仍无显著差异。我们发现，与第二代DES相比，DCB血管成形术的死亡率结果无差异，中位随访时间为33个月。因此，对于合适的患者，DCB可被视为治疗LMS疾病的一种安全选择。
