Gao Guofeng, Wang Hao-Yu, Song Yanjun, Yin Dong, Feng Lei, Wang Hao, Xu Han, Zhao Zhiyong, Yang Min, Lu Yingming, Ji Zheng, Zhu Chenggang, Dou Kefei
Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.
State Key Laboratory of Cardiovascular Disease, 100037 Beijing, China.
Rev Cardiovasc Med. 2023 Oct 7;24(10):277. doi: 10.31083/j.rcm2410277. eCollection 2023 Oct.
Drug-coated balloons (DCB) have been evaluated to be safe and practical in treating coronary small vessel disease (SVD). However, evidence about the practicality and safety of DCB in treating coronary lesions with diameters greater than 3.0 mm is limited.
1166 patients who received DCB angioplasty were enrolled and divided into groups of SVD or large vessel disease (LVD) according to the target vessel diameters ( 3.0 mm for SVD; 3.0 mm for LVD). All participants received a 2-year follow-up. The two main outcomes were patient-oriented composite endpoint (patient-oriented composite endpoint (POCE), all-cause mortality, all myocardial infarctions [MI], or any revascularization), and target lesion failure (target lesion failure (TLF), cardiac death, target vessel MI, or ischemia-driven target lesion revascularization).
In these patients, a total of 30 (2.6%) TLF and 82 (7.0%) POCE were recorded. Patients in the LVD group showed statistically greater rates of lesion success compared to the SVD group (752 [96.0%] vs. 380 [99.2%], = 0.004) and procedural success (751 [95.9%] vs. 380 [99.2%], = 0.003). No significant difference was found in the 2-year risk of TLF (hazard ratio (HR) 1.41, 95% CI 0.58-3.44; = 0.455), POCE (HR 1.29, 95% CI 0.76-2.20; = 0.354), MI (HR 0.88, 95% CI 0.24-3.13; = 0.837), revascularization (HR 1.22, 95% CI 0.68-2.21; = 0.506), and stroke (HR 0.78, 95% CI 0.03-15.26; = 0.784) between the SVD and LVD groups.
There was no discernible inferiority of the DCB intervention in the LVD group as compared to the SVD group. The DCB intervention is practical for coronary lesions with diameters higher than 3.0 mm.
药物涂层球囊（DCB）已被评估在治疗冠状动脉小血管疾病（SVD）中是安全且实用的。然而，关于DCB治疗直径大于3.0 mm冠状动脉病变的实用性和安全性的证据有限。
纳入1166例行DCB血管成形术的患者，根据靶血管直径分为SVD组或大血管疾病（LVD）组（SVD组靶血管直径≤3.0 mm；LVD组靶血管直径＞3.0 mm）。所有参与者均接受为期2年的随访。两个主要结局为以患者为导向的复合终点（以患者为导向的复合终点（POCE），全因死亡率、所有心肌梗死[MI]或任何血管重建）和靶病变失败（靶病变失败（TLF），心源性死亡、靶血管MI或缺血驱动的靶病变血管重建）。
在这些患者中，共记录到30例（2.6%）TLF和82例（7.0%）POCE。LVD组患者的病变成功率在统计学上高于SVD组（752例[96.0%]对380例[99.2%]，P = 0.004），手术成功率也更高（751例[95.9%]对380例[99.2%]，P = 0.003）。SVD组和LVD组在2年的TLF风险（风险比（HR）1.41，95%可信区间0.58 - 3.44；P = 0.455）、POCE风险（HR 1.29，95%可信区间0.76 - 2.20；P = 0.354）、MI风险（HR 0.88，95%可信区间0.24 - 3.13；P = 0.837）、血管重建风险（HR 1.22，95%可信区间0.68 - 2.21；P = 0.506）和卒中风险（HR 0.78，95%可信区间0.03 - 15.26；P = 0.784）方面未发现显著差异。
与SVD组相比，LVD组的DCB干预没有明显劣势。DCB干预对于直径大于3.0 mm的冠状动脉病变是实用的。
