慢性全闭塞伴远端弥漫性疾病的PCI治疗：单独支架vs支架+药物球囊

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-08-02 DOI:10.1016/j.ijcha.2025.101762

Xinyi Yan , Xinchen Gao , Yingying Hu , Jianlei Cao , Wei Zhang , Yi Lu , Jia Zhou , Qingqing Wu , Xiaorong Hu

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引用次数: 0

摘要

慢性冠状动脉全闭塞（CTO）是经皮冠状动脉介入治疗（PCI）的一个重大挑战。尽管成功的血管重建，患者经常出现弥漫性冠状动脉病变，增加再狭窄的风险，需要复杂的支架策略。目的比较药物洗脱支架（DES）联合药物包被球囊（DCB）血管成形术治疗血管重建术合并弥漫性冠状动脉疾病患者与仅使用药物洗脱支架（DES）治疗的临床效果。方法将血管重建成功的CTO弥漫性病变患者分为单纯DES组（n = 191）和DES + DCB组（n = 100）。主要终点是主要不良心血管事件（MACE），包括全因死亡、心源性死亡、中风和血运重建术。次要终点是心血管相关住院率。使用加拿大心血管学会（CCS）分类评估症状改善情况。结果随访24个月，DES + DCB组MACE发生率（26.00%比41.36%,P = 0.008）和心血管相关住院率（20.00%比36.65%,P = 0.005）显著低于单纯DES组。DES + DCB组的CCS分级改善更为显著(P <；0.001)。多因素Cox回归发现DES + DCB是MACE的独立保护因素(HR, 0.57；95% ci, 0.33-0.99；P = 0.046)。结论在血管重建的CTO和弥漫性冠状动脉疾病患者中，与单纯DES治疗相比，DES + DCB联合治疗可降低MACE发生率和心血管相关住院率。这种方法可能是处理复杂冠状动脉病变的一种优越的治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

PCI for Chronic Total Occlusions with Distal Diffuse Disease: Stent Alone vs. Stent plus Drug Balloon

查看原文本刊更多论文

PCI for Chronic Total Occlusions with Distal Diffuse Disease: Stent Alone vs. Stent plus Drug Balloon

Background

Chronic total occlusion (CTO) of coronary arteries is a significant challenge in percutaneous coronary intervention (PCI). Despite successful revascularization, patients often develop diffuse coronary lesions, increasing the risk of restenosis and necessitating complex stent strategies.

Objective

This study aimed to compare the clinical outcomes of drug-eluting stents (DES) combined with drug-coated balloon (DCB) angioplasty versus DES-only treatment in patients with revascularized CTO and diffuse coronary artery disease.

Methods

Patients with successfully revascularized CTO and diffuse lesions were divided into DES-only (n = 191) and DES plus DCB (n = 100) groups. The primary endpoint was major adverse cardiovascular events (MACE), including all-cause death, cardiac death, stroke, and revascularization. The secondary endpoint was the rate of cardiovascular-related hospitalization. Symptom improvement was evaluated using the Canadian Cardiovascular Society (CCS) classification.

Results

At 24-month follow-up, the DES plus DCB group had significantly lower MACE incidence (26.00 % vs. 41.36 %, P = 0.008) and cardiovascular-related hospitalization (20.00 % vs. 36.65 %, P = 0.005) compared to the DES-only group. CCS classification improved more significantly in the DES plus DCB group (P < 0.001). Multivariate Cox regression identified DES plus DCB as an independent protective factor against MACE (HR, 0.57; 95 % CI, 0.33–0.99; P = 0.046).

Conclusion

In patients with revascularized CTO and diffuse coronary artery disease, the combined DES plus DCB strategy was associated with a lower incidence of MACE and reduced cardiovascular-related hospitalization compared to DES-only treatment. This approach may represent a superior therapeutic option for managing complex coronary lesions.

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.