IVUS-guided rotational atherectomy versus cutting balloon for treating calcified lesions in left main coronary artery with single stent crossover: one year follow-up analysis
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摘要: 目的:探讨在血管内超声(IVUS)指导下行冠状动脉(冠脉)旋磨对比切割球囊在左主干钙化病变单支架术式中应用的疗效与安全性,为临床提供参考。方法:回顾性纳入左主干钙化病变行单支架术式的79例患者,按预处理方式分为旋磨组(26例)和切割球囊组(53例)。比较两组患者基本资料、病变特点、PCI终点并发症及1年主要心血管不良事件(MACE)。采用单因素和多因素Cox回归分析MACE的危险因素。结果:旋磨组术后即刻左主干最小支架内面积[(10.26±1.63) mm2∶(11.27±2.09) mm2,P=0.020]和前降支管腔面积[(7.50±0.72) mm2∶(8.21±1.75)mm2,P=0.012]显著大于切割球囊组。两组患者PCI并发症发生率无统计学差异。K-M曲线显示两组患者1年MACE发生率无统计学差异(P=0.824)。单因素和多因素Cox回归分析显示,边支受压(OR:7.561,95%CI:1.494~38.255,P=0.014)、支架膨胀不良(OR:12.124,95%CI:1.529~96.152,P=0.018)和最终血流小于TIMI 3级(OR:19.803,95%CI:1.973~198.791,P=0.011)是1年MACE发生的独立危险因素。结论:在IVUS指导下对行单支架术式的左主干尾部钙化病变进行冠脉旋磨与切割球囊相比可以使PCI术后即刻获得更大管腔面积,且安全性相当。Abstract: Objective: To investigate the efficacy and safety of intravascular ultrasound(IVUS)-guided rotational atherectomy contrast cutting balloon in left main(LM) coronary artery calcified lesions with single stent and to provide reference for clinical practice.Methods: A total of 79 patients with the calcified lesions of left main underwent single stent from January 2016 to December 2018 were reviewed. According to the pretreatment methods, they were divided into rotary group(n=26) and cutting balloon group(n=53). The basic data, lesion characteristics, percutaneous coronary intervention(PCI) end-point complications, and 1-year major adverse cardiovascular events(MACE) were compared between the two groups. Univariate and multivariate Cox regression analysis were used to analyze the risk factors of MACE.Results: The immediate minimum stent area of left main([10.26±1.63]mm2vs [11.27±2.09]mm2, P=0.020) and lumen area of left anterior descending branch(LAD)([7.50±0.72]mm2vs [8.21±1.75]mm2, P=0.012)in the rotary group were significantly larger than those in the cutting balloon group. There was no significant difference in the incidence of PCI complications between the two groups. K-M curves showed that there was no significant difference in the incidence of one year MACE(P=0.824). Univariate and multivariate Cox regression analysis showed that side branch compression(OR: 7.561, 95%CI: 1.494-38.255, P=0.014), stent under expansion(OR: 12.124, 95%CI: 1.529-96.152, P=0.018), and final blood flow less than TIMI 3 grade(OR: 19.803, 95%CI: 1.973-198.791, P=0.011) were independent risk factors of one year MACE.Conclusion: Under the guidance of IVUS, compare with cutting balloon, rotational atherectomy can obtain larger minimum stent area of LM and LAD immediately after PCI, and the safety is equivalent.
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