Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Department of Cardiology, Yuncheng Central Hospital, Shanxi, People's Republic of China.
Clin Cardiol. 2023 Dec;46(12):1511-1518. doi: 10.1002/clc.24140. Epub 2023 Sep 4.
The hybrid strategy of a combination of drug-eluting stent (DES) and drug-coated balloon (DCB) is promising for the treatment of de novo diffuse coronary artery disease (CAD).
To investigate the efficacy and functional results of hybrid strategy.
This case series study included patients treated with a hybrid approach for de novo diffuse CAD between February 2017 and November 2021. Postprocedural quantitative flow ratio (QFR) was used to evaluate the functional results. The primary endpoint was procedural success rate. The secondary endpoints were major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction (MI) (including peri-procedural MI), and target vessel revascularization.
A total of 109 patients with 114 lesions were treated. DES and DCB were commonly used in larger proximal segments and smaller distal segments, respectively. The mean QFR value was 0.9 ± 0.1 and 105 patients (96.3%) had values >0.8 in all the treated vessels. Procedural success was achieved in 106 (97.2%) patients. No cases of cardiac death were reported at a median follow-up of 19 months. Spontaneous MI occurred in three (2.8%) patients and target vessel revascularization in six (5.5%) patients. Estimated 2-year rate of MACE excluding peri-procedural MI was higher in the group with lower QFR value (12.1 ± 5.7% vs. 5.6 ± 4.4%, log-rank p = .035) (cut-off value 0.9).
Hybrid strategy is a promising approach for the treatment of de novo diffuse CAD. Postprocedural QFR has some implications for prognosis and may be helpful in guiding this approach.
药物洗脱支架（DES）和药物涂层球囊（DCB）联合的杂交策略对治疗新发弥漫性冠状动脉疾病（CAD）很有前景。
研究杂交策略的疗效和功能结果。
本病例系列研究纳入了 2017 年 2 月至 2021 年 11 月期间采用杂交方法治疗新发弥漫性 CAD 的患者。术后定量血流比（QFR）用于评估功能结果。主要终点是手术成功率。次要终点是主要不良心血管事件（MACE），包括心源性死亡、心肌梗死（MI）（包括围手术期 MI）和靶血管血运重建。
共 109 例患者 114 处病变接受治疗。DES 和 DCB 分别常用于较大的近段和较小的远段。平均 QFR 值为 0.9±0.1，所有治疗血管中 105 例（96.3%）患者的 QFR 值>0.8。106 例（97.2%）患者手术成功。中位随访 19 个月时无心源性死亡病例报告。3 例（2.8%）患者发生自发性 MI，6 例（5.5%）患者发生靶血管血运重建。在 QFR 值较低的患者中，MACE（不包括围手术期 MI）的估计 2 年发生率较高（12.1±5.7%比 5.6±4.4%，对数秩检验 p=0.035）（临界值 0.9）。
杂交策略是治疗新发弥漫性 CAD 的一种很有前途的方法。术后 QFR 对预后有一定的提示作用，可能有助于指导这种方法。
