Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.).
IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.).
Circ Cardiovasc Interv. 2023 Dec;16(12):e013232. doi: 10.1161/CIRCINTERVENTIONS.123.013232. Epub 2023 Oct 24.
Drug-coated balloons (DCB) are an emerging tool for modern percutaneous coronary intervention (PCI), but evidence on their use for de novo lesions on large vessels is limited.
Consecutive patients undergoing DCB-based PCI on the left anterior descending artery in 2 Italian centers from 2018 to 2022 were retrospectively enrolled and compared with patients who received left anterior descending PCI with contemporary drug-eluting stents (DES). In-stent restenosis was excluded. The DCB group included both patients undergoing DCB-only PCI and those receiving hybrid PCI with DCB and DES combined. The primary end point was target lesion failure at 2 years, defined as the composite of target lesion revascularization, cardiac death, and target vessel myocardial infarction.
We included 147 consecutive patients undergoing DCB-based treatment on the left anterior descending artery and compared them to 701 patients who received conventional PCI with DES. In the DCB group, 43 patients (29.2%) were treated with DCB only and 104 (70.8%) with a hybrid approach; DCB length was greater than stent length in 55.1% of cases. Total treated length was higher in the DCB group (65 [40-82] versus 56 [46-66] mm; =0.002), while longer DESs were implanted (38 [24-62] versus 56 [46-66] mm; <0.001) and a higher rate of large vessels were treated (76.2% versus 83.5%; =0.036) in the DES cohort. The cumulative 2-year target lesion failure incidence was not significantly different between the 2 groups (DCB, 4.1% versus DES, 9.8%; hazard ratio, 0.51 [95% CI, 0.20-1.27]; =0.15). After a 1:1 propensity score matching resulting in 139 matched pairs, the DCB-based treatment was associated with a lower risk for target lesion failure at 2 years compared with DES-only PCI (hazard ratio, 0.2 [95% CI, 0.07-0.58]; =0.003), mainly driven by less target lesion revascularization.
A DCB-based treatment approach for left anterior descending revascularization allows a significantly reduced stent burden, thereby potentially limiting target lesion failure risk at midterm follow-up.
药物涂层球囊（DCB）是现代经皮冠状动脉介入治疗（PCI）的一种新兴工具，但关于其在大血管新发病变中的应用证据有限。
回顾性纳入 2018 年至 2022 年期间在意大利的 2 个中心接受基于 DCB 的 PCI 治疗的左前降支连续患者，并与接受现代药物洗脱支架（DES）治疗的患者进行比较。排除支架内再狭窄。DCB 组包括仅接受 DCB 治疗的患者和接受 DCB 和 DES 联合治疗的杂交 PCI 的患者。主要终点是 2 年时的靶病变失败，定义为靶病变血运重建、心源性死亡和靶血管心肌梗死的复合终点。
我们纳入了 147 例接受基于 DCB 的左前降支治疗的连续患者，并与 701 例接受 DES 常规 PCI 的患者进行了比较。在 DCB 组中，43 例（29.2%）患者仅接受 DCB 治疗，104 例（70.8%）患者接受杂交治疗；55.1%的病例中 DCB 长度大于支架长度。DCB 组的总治疗长度较高（65 [40-82] 与 56 [46-66]；=0.002），而植入的 DES 更长（38 [24-62] 与 56 [46-66]；<0.001），治疗的大血管比例更高（76.2%与 83.5%；=0.036）。两组的 2 年累积靶病变失败发生率无显著差异（DCB 组为 4.1%，DES 组为 9.8%；风险比，0.51[95%CI，0.20-1.27]；=0.15）。在进行 1:1 倾向评分匹配后得到 139 对匹配后，与仅 DES 组相比，基于 DCB 的治疗在 2 年时靶病变失败的风险较低（风险比，0.2[95%CI，0.07-0.58]；=0.003），主要是由于靶病变血运重建减少。
左前降支血运重建的 DCB 治疗方法可显著降低支架负荷，从而可能降低中期随访时靶病变失败的风险。
