旋磨与球囊预扩张治疗冠状动脉重度钙化病变的疗效分析

目的研究旋磨与球囊预扩张后植入药物支架对治疗冠状动脉钙化病变的疗效。方法选取接受PCI治疗的冠状动脉重度钙化患者,按随机数字表法分为行旋磨术后支架植入(旋磨组,32例)和球囊预扩张支架植入(对照组,40例),对其进行前瞻性随机对照研究,比较两组治疗特征、围手术期并发症,分析6个月内主要不良心脑血管事件(MACCE)的危险因素。结果旋磨组平均支架直径显著大于对照组3.25(3.00,3.50)mm比3.00(2.81,3.25)mm,P=0.002]。旋磨组球囊预扩张次数、预扩张最大压力、球囊后扩张次数和后扩张最大压力均显著低于对照组,差异均有统计学意义(P<0.05)。旋磨组术后管腔直径大于对照组(3.34±0.28)mm比(3.15±0.27)mm,P=0.005]。旋磨组手术即刻成功率(96.9%)大于对照组(92.5%),总MACCE发生率(9.4%)低于对照组(22.5%),但差异无统计学意义(P>0.05)。PCI手术史危险比(RR)为1.155(95%CI 0.030~0.691,P=0.015)]及球囊预扩张最大压力危险比(RR)为2.326(95%CI 0.721~0.988,P=0.035)]是6个月内MACCE发生的独立危险因素。结论SYNTAX评分为23~32分的冠状动脉重度钙化病变,旋磨术有提高手术即刻成功率、降低短期不良事件的趋势,PCI手术史、球囊预扩张最大压力是6个月内MACCE发生的独立危险因素。

Rotational atherectomy versus balloon pre-dilated for treating heavily calcified coronary lesions

Aim To study the efficacy of rotational atherectomy(RA)versus balloon pre-dilated combined with drug eluting stent(DES)implatation in the treatment of heavily calcified coronary lesions.Methods The study selected patients with heavily calcified coronary lesions admitted in Fuyang City People’s Hospital from October 2017 to October 2018 who were going to receive PCI.The patients were divided into two groups according to the random number table,which were the RA combined with DES group(observation group,n=32)and the balloon pre-dilated combined with DES(control group,n=40).Prospective randomized controlled study was performed.The treatment characteristics and perioperative complications were compared between the two groups.The risk factors of major adverse cardiovascular and cerebrovascular events(MACCE)within 6 months were analyzed.Results The average stent diameter was significantly higher in the observation group than in the control group(3.25(3.00,3.50)mm vs 3.00(2.81,3.25)mm,P=0.002).The number of balloon pre-dilated,pre-dilated maximum pressure,the number of balloon post-dilated and post-dilated maximum pressure were significantly lower in the observation group than in the control group(P<0.05).The lumen diameter after PCI was significantly larger in the observation group than in the control group((3.34±0.28)mm vs(3.15±0.27)mm,P=0.005).The procedural success rate of the observation group(96.9%)was higher than that of the control group(92.9%),the incidence of total MACCE in the observation group(9.4%)was lower than in the control group(22.5%),but there is no significant differences between the two groups(P>0.05).The previous PCI(risk ration:1.155,95%CI:0.030~0.691,P=0.015)and the maximum pressure of balloon pre-dilated(risk ration:2.326,95%CI:0.721~0.988,P=0.035)were independent risk factors for MACCE within 6 months.Conclusions For severely calcified coronary lesions with a SYNTAX score of 23 to 32,RA has tendencies to improve the procedural success rate and reduce short-term adverse events.The previous PCI and the maximum pressure of pre-dilated were independent risk factors for MACCE within 6 months.