Sanz-Sánchez Jorge, Teira Calderón Andrea, Neves David, Cortés Villar Carlos, Lukic Antonela, Rumiz González Eva, Sánchez-Elvira Guillermo, Patricio Lino, Díez-Gil José Luis, García-García Héctor M, Martínez Dolz Luis, San Román J Alberto, Amat Santos Ignacio
Hospital Universitari i Politecnic La Fe, 46026 Valencia, Spain.
Centro de Investigación Biomedica en Red (CIBERCV), 28029 Madrid, Spain.
J Clin Med. 2025 Jan 28;14(3):869. doi: 10.3390/jcm14030869.
: Drug-eluting stents (DESs) remain the standard of treatment for patients with ST-elevation myocardial infarction (STEMI). However, complications such as stent thrombosis and in-stent restenosis still pose significant risks. Drug-coated balloons (DCBs) have emerged as a promising alternative, but data for this clinical scenario are still scarce. The objective was to evaluate the safety and efficacy of DCB culprit-lesion primary percutaneous coronary intervention (pPCI) in patients presenting with STEMI and to evaluate its impact on the microcirculatory territory. : An observational retrospective study was conducted across six European centers. : In total, 118 patients were included. Of these, 82.2% were male, with a median age of 67 years (IQR 36-92); 28% patients presented with stent thrombosis and most of them (94%) underwent paclitaxel-DCB-pPCI. The median follow-up was 23.2 months (IQR 6.7-77.3). Target lesion failure (TLF) rates were low (3.4%), with no differences between patients presenting with native coronary vessel and stent thrombosis (4.7% vs. 0%; = 0.205). Overall mortality rates at follow-up were 7%, with only 1.8% attributed to cardiac causes. A target lesion revascularization (TLR) rate of 1.8% was observed, with no target vessel myocardial infarction reported. A subgroup of patients (42; 35.6%) underwent an adenosine-free angiographic microvascular resistance (AMR) analysis. The median AMR was 4.7 (3.9-5.5) and was greater in the stent thrombosis group than in the native coronary group (5.1 vs. 4.6; = 0.038) with no clinical differences between patients based on the AMR. : DCB-pPCI has emerged as an alternative potential treatment for patients presenting with STEMI, with few long-term adverse cardiac events. Despite the encouraging outcomes, these findings underscore the need for a large randomized clinical trial powered by a relevant clinical outcome in order to elucidate the role of DCB-PCI in patients presenting with STEMI.
药物洗脱支架（DESs）仍然是ST段抬高型心肌梗死（STEMI）患者的标准治疗方法。然而，诸如支架血栓形成和支架内再狭窄等并发症仍然构成重大风险。药物涂层球囊（DCBs）已成为一种有前景的替代方案，但针对这种临床情况的数据仍然很少。目的是评估DCB罪犯病变直接经皮冠状动脉介入治疗（pPCI）在STEMI患者中的安全性和有效性，并评估其对微循环区域的影响。：在六个欧洲中心进行了一项观察性回顾性研究。：总共纳入了118例患者。其中，82.2%为男性，中位年龄为67岁（四分位间距36 - 92岁）；28%的患者出现支架血栓形成，其中大多数（94%）接受了紫杉醇-DCB-pPCI治疗。中位随访时间为23.2个月（四分位间距6.7 - 77.3个月）。靶病变失败（TLF）率较低（3.4%），原发性冠状动脉血管病变患者和支架血栓形成患者之间无差异（4.7%对0%；P = 0.205）。随访时的总死亡率为7%，仅1.8%归因于心脏原因。观察到靶病变血运重建（TLR）率为1.8%，未报告靶血管心肌梗死。一组患者（42例；35.6%）接受了无腺苷血管造影微血管阻力（AMR）分析。中位AMR为4.7（3.9 - 5.5），支架血栓形成组高于原发性冠状动脉组（5.1对4.6；P = 0.038），基于AMR的患者之间无临床差异。：DCB-pPCI已成为STEMI患者的一种潜在替代治疗方法，长期不良心脏事件较少。尽管结果令人鼓舞，但这些发现强调需要进行一项由相关临床结果驱动的大型随机临床试验，以阐明DCB-PCI在STEMI患者中的作用。
