血管内超声指导药物涂层球囊的临床价值

Clinical Value of Intravascular Ultrasound-Guided Drug-Coated Balloons

摘要: 目的：探讨血管内超声(IVUS)指导药物涂层球囊(DCB)治疗冠状动脉原位病变的临床价值。方法：2019年7月至2021年7月在青岛市立医院心内科住院的270名急性冠状动脉综合征患者，他们接受了IVUS或冠脉造影(CAG)指导下的DCB治疗，且影像学显示为原位病变，将他们分为冠脉造影组(n = 170)和血管内超声组(n = 100)，统计两组的术中并发症情况和出院后1年内发生的主要不良心血管事件(MACE)。结果：与冠状动脉造影引导的DCB治疗相比，IVUS的应用降低了MACE事件的发生率(38.2% vs 19.0%, P = 0.01)，特别是在急性冠脉综合征(28.8% vs 18.0%, P = 0.047)和中风(4.4% vs 0%, P = 0.049)方面。两组在1年随访中出现心源性死亡和急性心力衰竭的差异性分析没有统计学意义，其中，CAG组有1例心脏死亡，而IVUS组未出现心源性死亡病例。结论：对于有冠状动脉原位病变的急性冠脉综合征患者，IVUS指导药物涂层球囊具有更高的临床效益，可以减少MACE事件的发生，改善患者的预后。

Abstract: Objective: To investigate the clinical value of intravascular ultrasound (IVUS)-guided drug-coated balloon (DCB) for the treatment of coronary artery lesions in situ. Methods: 270 patients with acute coronary syndrome who were hospitalized in the Department of Cardiology of Qingdao Municipal Hospital from July 2019 to July 2021, who underwent IVUS or coronary angiography (CAG)-guided DCB and whose imaging showed in situ lesions, were divided into the coronary angiography group (n = 170) and the intravascular ultrasound group (n = 100), and the intraoperative complications and major adverse cardiovascular events (MACE) occurring within 1 year after hospital discharge of both groups were counted. Results: Compared with coronary angiography-guided DCB treatment, the use of IVUS reduced the incidence of MACE events (38.2% vs 19.0%, P = 0.01), especially in acute coronary syndrome (28.8% vs 18.0%, P = 0.047) and stroke (4.4% vs 0%, P = 0.049). There was no statistically significant difference analysis between the two groups in terms of cardiac death and acute heart failure at 1-year follow-up, with one cardiac death in the CAG group and no case of cardiac death in the IVUS group. CONCLUSION: In patients with acute coronary syndromes with coronary artery in situ lesions, IVUS-guided drug-coated balloons have a higher clinical benefit in reducing the occurrence of MACE events and improving patient prognosis.