药物涂层球囊在急性心肌梗死直接经皮冠状动脉介入术中的应用

doi:10.3969/j.issn.1006-7795.2023.04.025

首都医科大学学报 ›› 2023, Vol. 44 ›› Issue (4): 669-675.doi: 10.3969/j.issn.1006-7795.2023.04.025

药物涂层球囊在急性心肌梗死直接经皮冠状动脉介入术中的应用

周力¹, 朱超¹, 王福财², 崔贺贺¹, 刘青波¹, 赵慧强^1*, 陈晖¹

1.首都医科大学附属北京友谊医院心血管中心，北京 100050；2.内蒙古自治区库伦旗人民医院心内科，内蒙古自治区通辽 028200

收稿日期:2023-02-20 出版日期:2023-08-21 发布日期:2023-07-26
通讯作者: 赵慧强 E-mail:zhaohq05@aliyun.com
基金资助:
北京市医管中心科研培育计划项目（ PX2020006）

Drug-coated balloons in primary percutaneous coronary intervention for acute myocardial infarction

Zhou Li¹, Zhu Chao¹, Wang Fucai², Cui Hehe¹, Liu Qingbo¹, Zhao Huiqiang^1*，Chen Hui¹

1.Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; 2.Department of Cardiology, Kulun Banner People's Hospital, Tongliao 028200, Inner Mongolia Autonomous Region, China

Received:2023-02-20 Online:2023-08-21 Published:2023-07-26
Supported by:
This study was supported by Beijing Municipal Administration of Hospitals Incubating Program (PX2020006).

摘要/Abstract

摘要： 目的评估药物涂层球囊（drug-coated balloon,DCB）在急性心肌梗死患者直接经皮冠状动脉介入术（percutaneous coronary intervention,PCI）中的应用效果。方法以 2018年8月至2022年7月在首都医科大学附属北京友谊医院接受直接PCI并应用DCB处理罪犯病变的75例急性心肌梗死患者为研究对象，回顾性分析其临床资料、冠状动脉病变特点以及预后情况。结果手术成功率为 100%，住院期间临床不良事件发生率为8%。30 d随访中，有2例（2.7%）患者因心力衰竭再入院。在中位时间为16个月的长期随访中，发生非致命性心肌梗死9例（12%）、靶病变血运重建 5例（6.7%）、心力衰竭再入院4例（5.3%）、脑卒中3例（4%）。长期累积主要不良心脑血管事件（main adverse cardiovascular and cerebrovascular events,MACCE）发生率为24%，Kaplan-Meier估测长期无MACCE生存率为63.6%（47.3%~79.8%）。结论对于急性心肌梗死中的高选择病变，如原支架内闭塞、小血管病变以及分叉病变，直接PCI时应用DCB血管成形术成功率高，长期预后较好。

关键词: 药物涂层球囊, 急性心肌梗死, 直接经皮冠状动脉介入术

Abstract: Objective This study was to evaluate the efficacy of drug-coated balloons(DCB) for acute myocardial infarction (AMI).Methods A total of 75 AMI patients who underwent primary percutaneous coronary intervention(PCI)with DCB treatment of culprit lesion in Beijing Friendship Hospital, Capital Medical University, from August 2018 to July 2022 were enrolled in this study. The clinical data, characteristics of coronary artery lesion and prognosis were retrospectively analyzed.Results The procedural success rate was 100%, and the incidence of clinical adverse events in hospitalization was 8%. During the 30-day follow-up, 2 patients (2.7%) were readmitted for heart failure. During a median follow-up of 16 months, there were 9 cases (12%) of non-fatal myocardial infarction, 5 cases (6.7%) of target lesion revascularization, 4 cases (5.3%) of heart failure readmission, and 3 cases (4%) of stroke. The long-term cumulative main adverse cardiovascular and cerebrovascular events (MACCE) rate was 24%, and the Kaplan-Meier estimated long-term MACCE-free survival rate was 63.6%（47.3%-79.8%）. Conclusions For specific lesions in AMI, such as in-stent occlusion, small vessel disease and bifurcation lesions, DCB angioplasty in primary PCI has a high success rate and a good long-term prognosis.

Key words: drug-coated balloon, acute myocardial infarction, percutaneous coronary intervention

中图分类号:

周力, 朱超, 王福财, 崔贺贺, 刘青波, 赵慧强, 陈晖. 药物涂层球囊在急性心肌梗死直接经皮冠状动脉介入术中的应用[J]. 首都医科大学学报, 2023, 44(4): 669-675.

Zhou Li, Zhu Chao, Wang Fucai, Cui Hehe, Liu Qingbo, Zhao Huiqiang, Chen Hui. Drug-coated balloons in primary percutaneous coronary intervention for acute myocardial infarction[J]. Journal of Capital Medical University, 2023, 44(4): 669-675.

参考文献

［1］陈韵岱, 王建安, 刘斌, 等. 药物涂层球囊临床应用中国专家共识［J］. 中国介入心脏病学杂志, 2016, 24(2): 61-67.
［2］ Jeger R V, Eccleshall S, Wan Ahmad W A, et al. Drug-coated balloons for coronary artery disease: third report of the International DCB Consensus Group［J］. JACC Cardiovasc Interv, 2020, 13(12): 1391-1402.
［3］ Nakazawa G, Finn A V, Joner M, et al. Delayed arterial healing and increased late stent thrombosis at culprit sites after drug-eluting stent placement for acute myocardial infarction patients: an autopsy study［J］. Circulation, 2008, 118(11): 1138-1145.
［4］ Gonzalo N, Barlis P, Serruys P W, et al. Incomplete stent apposition and delayed tissue coverage are more frequent in drug-eluting stents implanted during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction than in drug-eluting stents implanted for stable/unstable angina: insights from optical coherence tomography［J］. JACC Cardiovasc Interv, 2009, 2(5): 445-452.
［5］ Fang C Y, Fang H Y, Chen C J, et al. Comparison of clinical outcomes after drug-eluting balloon and drug-eluting stent use for in-stent restenosis related acute myocardial infarction: a retrospective study［J］. PeerJ, 2018, 6: e4646.
［6］ Vos N S, Dirksen M T, Vink M A, et al. Safety and feasibility of a PAclitaxel-eluting balloon angioplasty in Primary Percutaneous coronary intervention in Amsterdam (PAPPA): one-year clinical outcome of a pilot study［J］. EuroIntervention, 2014, 10(5): 584-590.
［7］ Vos N S, Fagel N D, Amoroso G, et al. Paclitaxel-coated balloon angioplasty versus drug-eluting stent in acute myocardial infarction: the REVELATION randomized trial［J］. JACC Cardiovasc Interv, 2019, 12(17): 1691-1699.
［8］许骥, 华琦, 胡少东, 等. 替格瑞洛在老年STEMI患者急诊PCI中的疗效与安全性分析［J］. 首都医科大学学报, 2015, 36(1): 73-77.
［9］ Gibson C M, De Lemos J A, Murphy S A, et al. Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy［J］. Circulation, 2001, 103(21): 2550-2554.
［10］ Neumann F J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. The Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS)［J］. G Ital Cardiol (Rome), 2019, 20(7/8 Suppl 1): 1S-61S.
［11］ De Luca G, Suryapranata H, Stone G W, et al. Coronary stenting versus balloon angioplasty for acute myocardial infarction: a meta-regression analysis of randomized trials［J］. Int J Cardiol, 2008, 126(1): 37-44.
［12］ Scheller B, Ohlow M A, Ewen S, et al. Bare metal or drug-eluting stent versus drug-coated balloon in non-ST-elevation myocardial infarction: the randomised PEPCAD NSTEMI trial［J］. EuroIntervention, 2020, 15(17): 1527-1533.
［13］ Stefanini G G, Alfonso F, Barbato E, et al. Management of myocardial revascularisation failure: an expert consensus document of the EAPCI［J］. EuroIntervention, 2020, 16(11): e875-e890.
［14］ Joner M, Koppara T, Byrne R A, et al. Neoatherosclerosis in patients with coronary stent thrombosis: findings from optical coherence tomography imaging (a report of the PRESTIGE consortium)［J］. JACC Cardiovasc Interv, 2018, 11(14): 1340-1350.
［15］ Enomoto S, Kuramitsu S, Shinozaki T, et al. Risk factors and outcomes of recurrent drug-eluting stent thrombosis: insights from the REAL-ST registry［J］. J Am Heart Assoc, 2021, 10(9): e018972.
［16］ Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)［J］. Eur Heart J, 2018, 39(2): 119-177.
［17］ Zhang Y X, Zhang X Y, Dong Q C, et al. Duration of dual antiplatelet therapy after implantation of drug-coated balloon［J］. Front Cardiovasc Med, 2021, 8: 762391.

药物涂层球囊在急性心肌梗死直接经皮冠状动脉介入术中的应用

Drug-coated balloons in primary percutaneous coronary intervention for acute myocardial infarction

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